Abstract:

Objective　To analyze the value of serum neuron specific enolase (NSE), S-100β, and C-reactive protein (CRP)/prealbumin (PA) in predicting short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia. Methods　The clinical data of 130 patients with severe cerebral contusion complicated with cerebral hernia who received decompressive craniectomy in Xi'an Gaoxin Hospital from May 2020 to May 2023 were retrospectively analyzed, including 85 males and 45 females, with an age of (55.13±10.33) years old. The Glasgow Coma Scale (GCS) score was 3-8 points in 56 cases, and >8 points in 74 cases. There were 79 cases of single brain contusion and 51 cases of multiple brain contusions. The patients' survival 30 days after operation was recorded. Twenty-six cases (20.00%) died in hospital and 104 cases (80.00%) were discharged successfully after treatment. Baseline data such as age and gender were collected in the two groups. Serum levels of NSE, S-100β, CRP, and PA were detected by enzyme linked immunosorbent assay (ELISA) and electrochemiluminescence method upon admission. The data were analyzed by t and χ² tests. Multivariate logistic regression analysis was used to analyze the risk factors of short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia, and the values of serum NSE, S-100β, and CRP/PA levels in predicting short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia were observed by the receiver operating characteristic curve (ROC). Results　The proportions of the patients with GCS score of 3-8, multiple cerebral contusion, and use of anticoagulants 1 week before admission and serum levels of NSE, S-100β, and CRP/PA in the death group were higher than those in the survival group (all P<0.05). Multivariate logistic regression analysis showed that GCS score at admission, site of cerebral contusion, use of anticoagulant drugs 1 week before admission, and serum NSE, S-100β, and CRP/PA levels were all risk factors for short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia (all P<0.05). ROC analysis confirmed that serum NSE, S-100β, and CRP/PA levels could be used to predict short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia, with the area under the curve of 0.795, 0.753, and 0.801, respectively (all P<0.05). Conclusions　GCS score at admission, site of cerebral contusion, use of anticoagulant drugs 1 week before admission, and serum NSE, S-100β, and CRP/PA levels are all risk factors for short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia. Clinical screening should be focused on high-risk patients with the above indicators, and timely interventions should be taken.

Key words:

Severe cerebral contusion, Cerebral hernia, Neuron specific enolase, S-100β, C-reactive protein, Prealbumin

摘要：

目的　分析血清神经元特异性烯醇化酶（NSE）、S-100β、C反应蛋白（CRP）/前白蛋白（PA）预测重度脑挫裂合并脑疝患者院内短期死亡的价值。方法　回顾性分析2020年5月至2023年5月在西安高新医院接受去骨瓣减压术治疗的130例重度脑挫裂合并脑疝患者的临床资料，男85例，女45例，年龄（55.13±10.33）岁；入院时格拉斯哥昏迷量表（GCS）评分3～8分56例，>8分74例；脑挫伤部位：单发79例，多发51例。记录术后30 d患者生存情况并进行分组，26例（20.00%）于院内死亡为死亡组，104例（80.00%）治疗后顺利出院为存活组。收集两组年龄、性别等基线资料，入院时采用酶联免疫吸附法和电化学发光法检测血清NSE、S-100β、CRP、PA水平，并计算CRP/PA水平。采用t检验和χ²检验，采用多因素logistic回归分析法分析重度脑挫裂合并脑疝患者院内短期死亡的危险因素，以受试者操作特征曲线（ROC）观察血清NSE、S-100β、CRP/PA水平预测重度脑挫裂合并脑疝患者院内短期死亡的价值。结果　死亡组入院时格拉斯哥昏迷量表（GCS）评分3～8分、多发脑挫伤、入院前1周使用抗凝药物的患者占比以及血清NSE、S-100β、CRP/PA水平均高于存活组（均P<0.05）；多因素logistic回归分析显示，入院时GCS评分、脑挫伤部位、入院前1周使用抗凝药物及血清NSE、S-100β、CRP/PA水平均为重度脑挫裂合并脑疝患者院内短期死亡的危险因素（均P<0.05）；ROC分析证实血清NSE、S-100β、CRP/PA水平均可用于预测重度脑挫裂合并脑疝患者院内短期死亡，曲线下面积分别为0.795、0.753、0.801（均P<0.05）。结论　入院时GCS评分、脑挫伤部位、入院前1周使用抗凝药物、血清NSE、S-100β、CRP/PA水平均为重度脑挫裂合并脑疝患者院内短期死亡的危险因素，临床应结合以上指标对高危患者进行重点筛查，及时采取干预措施。

关键词:

重度脑挫裂, 脑疝, 神经元特异性烯醇化酶, S-100β, C反应蛋白, 前白蛋白