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Neurological Surgery No Shinkei Geka Volume 33, Issue 11 （November 2005）

Neurological Surgery 脳神経外科 33巻11号（2005年11月発行）

Japanese English

研究

神経外傷における血清S-100B蛋白，NSEの検討 Serum S-100B Protein and Neuron-Specific Enolase after Traumatic Brain Injury 沢内聡 ¹ , 田屋圭介 ² , 村上成之 ¹ , 石井卓也 ² , 大塚俊宏 ¹ , 加藤直樹 ¹ , 郭樟吾 ¹ , 田中俊英 ¹ , 諸岡暁 ³ , 結城研司 ³ , 浦島充佳 ⁴ , 阿部俊昭 ² Satoshi SAWAUCHI ¹ , Keisuke TAYA ² , Shigeyuki MURAKAMI ¹ , Takuya ISHII ² , Toshihiro OHTSUKA ¹ , Naoki KATO ¹ , Shougo KAKU ¹ , Toshihide TANAKA ¹ , Satoru MOROOKA ³ , Kenji YUHKI ³ , Mitsuyoshi URASHIMA ⁴ , Toshiaki ABE ² ¹東京慈恵会医科大学附属柏病院脳神経外科 ²東京慈恵会医科大学脳神経外科 ³富士市立中央病院脳神経外科 ⁴東京慈恵会医科大学臨床研究開発室 ¹Department of Neurosurgery,Jikei University School of Medicine,Kashiwa Hospital ²Department of Neurosurgery,Jikei University School of Medicine ³Department of Neurosurgery,Fuji City General Hospital ⁴Division of Clinical Research and Development,Jikei University School of Medicine キーワード： traumatic brain injury , S-100B protein , NSE , CT scan , secondary insult Keyword: traumatic brain injury , S-100B protein , NSE , CT scan , secondary insult pp.1073-1080

発行日 2005年11月1日 Published Date 2005/11/1

DOI https://doi.org/10.11477/mf.1436100144

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Ⅰ．はじめに

　現在，神経外傷の病態は画像所見により形態的に分類されているが，脳損傷がどの程度なのかを定量的に評価するのは困難である．近年，神経損傷のマーカーとして，血清S-100B蛋白およびneuron specific enolase（NSE）の有用性が注目されている^{1,3-5,8-13,17)}．S-100B蛋白はグリア細胞，NSEは神経細胞に存在するため，神経特異性が比較的高いとされる^{1,3-5,8-13,17)}．本研究は，頭部外傷後，急性期の血清S-100B蛋白，NSEが神経学的重症度の指標，および転帰の予測因子となり得るか，また，画像上の診断との関連を検討し，病態を解析することを目的とした．

Objective　The aim of this study was to investigate S-100B protein and NSE as a serum marker of brain cell damage after traumatic brain injury.

　Material and methods　Forty-one patients with traumatic brain injury were included in this prospective study. Venous blood samples for S-100B protein and NSE were taken after admission and on the next day. Serum levels of S-100 protein and NSE were compared with Glasgow Coma Scale score,computed tomographic findings and outcome after 3 months.

　Results　Serum S-100B protein and NSE were significantly correlated with Glasgow Coma Scale score and outcome after 3 months. The significant correlation was found between the initial S-100B and NSE (P＜0.001). In patients without parenchymal injuries on computed tomographic scan such as epidural hematoma and concussion,the elevation of S-100B protein and NSE was observed. The initial values of S-100B and NSE in acute subdural hematomas with unfavorable outcome were significantly higher than in those with favorable outcome. Secondary increase of serum markers was associated with the presence of secondary insult such as hypoxia or hypotension,and was found to have an unfavorable outcome.

　Conclusions　Serum concentration and kinetics of S-100B protein and NSE provide the clinical assessment of the primary brain damage and have a predictive value for outcome after traumatic brain injury.