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目的探讨血清 S100蛋白 B 亚型(S100B)和神经元特异性烯醇化酶(NSE)水平对早期判断体外循环手术后脑损伤的应用价值。方法心脏病手术患者48例,体外循环组(n=40)和非体外循环组(n=8),于手术前、后24 h 和48 h 检测血清 S100B 和 NSE 的浓度,术后48 h 根据“心脏术后神经功能状况评估法”计算脑损伤指数(DQ)。结果在体外循环术后24 h 和48 h 血清 S100B(0.61μg/L±0.18μg/L,0.37μg/L±0.12μg/L)和 NSE(10.14μg/L±3.87μg/L,5.77μg/L±2.31μg/L)的浓度均高于术前水平(0.05±0.03μg/L,2.98±1.49μg/L)(均 P<0.01),而非体外循环组术后 S100B(0.05μg/L±0.03μg/L,0.04μg/L±0.03μg/L)和 NSE(2.91μg/L±1.56μg/L,2.87μg/L±1.41μg/L)与术前浓度(0.04μg/L±0.03μg/L,2.76μg/L±1.23μg/L)无差异(均 P>0.05)。体外循环术后24 h 和血清 S100B 和 NSE 的水平与年龄、体外循环时间及主动脉阻断时间相关(均 P<0.05)。血清 S100B 和 NSE 的水平与 DQ 均呈正相关(r=0.739 P<0.01,r=0.371 P<0.05)。结论血清 S100B 和 NSE 均为判断体外循环术后脑损伤的特异性指标,但联合检测血清S100B 和 NSE 的特异性最高。
Objective To investigate the value of serum S100 protein subtype B (S100B) and neuron-specific enolase (NSE) levels in the early diagnosis of brain injury after cardiopulmonary bypass. Methods Serum levels of S100B and NSE were measured in 48 patients undergoing cardiothoracic surgery, cardiopulmonary bypass (n = 40) and non-cardiopulmonary bypass (n = 8) at 24 h and 48 h after surgery. “Assessment of neurological status after cardiac surgery ” Calculated brain injury index (DQ). Results Serum levels of S100B (0.61μg / L ± 0.18μg / L, 0.37μg / L ± 0.12μg / L) and NSE (10.14μg / L ± 3.87μg / L, 5.77μg / L) at 24 h and 48 h after cardiopulmonary bypass L ± 2.31μg / L) were higher than preoperative levels (0.05 ± 0.03μg / L, 2.98 ± 1.49μg / L respectively) (all P <0.01) ± 0.03μg / L, 0.04μg / L ± 0.03μg / L) and NSE (2.91μg / L ± 1.56μg / L, 2.87μg / L ± 1.41μg / L) μg / L, 2.76μg / L ± 1.23μg / L) (all P> 0.05). The levels of S100B and NSE at 24 hours after cardiopulmonary bypass were correlated with age, cardiopulmonary bypass time and aortic cross-clamping time (all P <0.05). Serum S100B and NSE levels were positively correlated with DQ (r = 0.739 P <0.01, r = 0.371 P <0.05). Conclusions Serum S100B and NSE are both specific indicators for judging brain injury after cardiopulmonary bypass, but the specificity of combined detection of serum S100B and NSE is the highest.