Prognostički značaj serumskih nivoa biohemijskih markera cerebralnog oštećenja u ranoj posttraumetskoj fazi kod pacijenata sa traumatskom lezijom mozga

Abstract

Uvod: Cilj studije je bio da se odrede serumske koncentracije proteina S100B i neuron specifične enolaze (NSE) i njihova sposobnost i preciznost u predikciji ranog neurološkog ishoda nakon traumatske lezije mozga. Materijal i metode: Stotrideset politraumatizovanih pacijenta sa udruženom traumatskom lezijom mozga je bilo uključeno u ovu prospektivnu kohortnu studiju. Serumski nivoi proteina S100B i NSE su mereni u 6, 24,48. i 72. satu nakon povređivanja. Rani neurološki ishod je procenjivan Glasgow Outcome Scale (GOS) skorom četrnaestog dana nakon povrede mozga. Rezultati: Koncentracije proteina S100B su bile maksimalne u 6. satu nakon povređivanja i praćene su naglim padom, a zatim sporijim oslobađanjem u naredna dva dana uz konstantno i signifikantno povišene vrednosti (p˂ 0.0001) kod pacijenata sa lošim ishodom. Sekundarni porast proteina S100B u 72. satu zabeležen je kod pacijenata koji su preminuli (GOS 1). Dinamiku promena za NSE karakteriše sekundarni porast koncentracija u 72. satu nakon povređivanja kod pacijenata sa lošim ishodom. Zaključak: Oba markera imaju dobru prediktivnu sposobnost lošeg neurološkog ishoda, mada NSE obezbeđuje bolji diskriminativni potencijal u 72. satu nakon povrede mozga, dok protein S100B ima bolji diskriminativni potencijal u predikciji mortaliteta.

Background: The objective of our study was determination of serum concentrations of protein S100B and neuron specific enolase (NSE) as well as their ability and accuracy in prediction of an early neurological outcome after the traumatic brain injury. Methods: A total of 130 politraumatised patients with the associated traumatic brain injuries were included in this prospective cohort study. Serum protein S100B and NSE levels were measured at 6, 24, 48 and 72 hours after the injury. Early neurological outcome was scored by Glasgow Outcome Scale (GOS) on day 14 after the brain injury. Results: The protein S100B concentrations were maximal at 6 hours after the injury, followed there upon by abrupt fall, and subsequently by slower release in the following two days with continual and significantly increased values (p˂0.0001) in patients with poor outcome. Secondary increase of protein S100B at 72 hours was recorded in patients with lethal outcome (GOS 1). Dynamics of NSE changes was characterized by secondary increase of concentrations at 72 hours after the injury in patients with poor outcome. Conclusion: Both markers have good predictive ability for poor neurological outcome, although NSE provides better discriminative potential at 72 hours after the brain injury, while protein S100B has better discriminative potential for mortality prediction.