饶克成;郭京立;王明国;蔡春雨;

• 1:南阳市第二人民医院

摘要(Abstract)：

目的探讨颅脑肿瘤患者血清神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)、红细胞分布宽度(RDW)与预后的相关性。方法选取2017-01—2019-01收治于南阳市第二人民医院的200例颅脑肿瘤患者为研究对象,均进行1 a随访,依据颅脑肿瘤患者随访后格拉斯哥预后评分(GOS)分为预后良好组(GOS≥3分)42例与预后不良组(GOS<3分)158例,对2组临床资料和血清NSE、MBP及RDW水平进行回顾性分析。结果单因素分析显示2组术前行为状态量表(KPS)、术后放化疗、颅外转移、血清NSE、血清MBP、RDW水平方面存在显著差异(P<0.05);多因素分析显示术后未放化疗、颅外转移、血清NSE水平≥10μg/L、血清MBP水平≥8μg/L和RDW水平≥15%是颅脑肿瘤患者预后不良的独立预测因素。ROC分析显示血清NSE、MBP及RDW水平联合预测颅脑肿瘤患者预后不良的AUC值明显高于三者单独预测时的AUC值(P<0.05),且NSE、MBP、RDW单独预测颅脑肿瘤预后不良时的截断值分别为12.206μg/L、18.439μg/L和15.588%。结论颅脑肿瘤患者的血清NSE、MBP及RDW水平可作为其预后的可靠标志物,三者联合检测对预测颅脑肿瘤患者预后有较高的价值。

关键词(KeyWords)： 颅脑肿瘤;神经元特异性烯醇化酶;髓鞘碱性蛋白;红细胞分布宽度;预后

Abstract:

Keywords:

基金项目(Foundation): 2019年河南省卫生厅医学科技攻关计划项目(编号:LHGJ20191471)

作者(Author): 饶克成;郭京立;王明国;蔡春雨;

Email:

DOI:

参考文献(References)：

• [1] AU A K,BELL M J,FINK E L,et al.Brain-Specific Serum Biomarkers Predict Neurological Morbidity in Diagnostically Diverse Pediatric Intensive Care Unit Patients[J].Neurocrit Care,2018,28(1):26-34.DOI:10.1007/s12028-017-0414-7.
• [2] 杨柳,王蒙,赵培超,等.颅脑肿瘤患者的预后影响因素分析[J].中国实用神经疾病杂志,2020,23(10):876-879.
• [3] LU Z,BAI X,XIONG L,et al.Effect of electroacupuncture preconditioning on serum S100beta and NSE in patients undergoing craniocerebral tumor resection[J].Chin J Integr Med,2010,16(3):229-233.DOI:10.1007/s11655-010-0229-6.
• [4] HUANG C,NONG S H,CHEN J M,et al.Effects of different arterial oxygen partial pressures on serum protein S100β and neuron specific enolase during cardiopulmonary bypass in infants with cyanotic congenital heart disease[J].Zhonghua Er Ke Za Zhi,2012,50(2):121-125.
• [5] YUAN J,WU Y,LI J Y,et al.Protection of Transcutaneous Acupoint Electrical Stimulation for Brain Injury Undergoing Intervention:a Clinical Observation[J].Zhongguo Zhong Xi Yi Jie He Za Zhi,2015,35(8):971-974.
• [6] ISHIDA K,GOHARA T,KAWATA R,et al.Are serum S100beta proteins and neuron-specific enolase predictors of cerebral damage in cardiovascular surgery?[J].J Cardiothorac Vasc Anesth,2003,17(1):4-9.DOI:10.1053/jcan.2003.2.
• [7] FENG H,FAN X,JIANG H.The changes of memory and their correlations to S100beta protein as well as neuron-specific enolase in patients with obstructive sleep apnea-hypopnea syndrome[J].Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2011,25(3):105-108.
• [8] GOVINDAN A,PARAMBIL R M,ALAPATT J P,et al.Pediatric Intracranial Tumors over a 5-Year Period in a Tertiary Care Center of North Kerala,India:A Retrospective Analysis[J].Asian J Neurosurg,2018,13(4):1112-1117.DOI:10.4103/ajns.AJNS_251_17.
• [9] BELTRáN J Q,SOTO-ABRAHAM J E,VIDAURRETA-SERRANO J,et al.Astrocytic Tumors in Mexico:An Overview of Characteristics and Prognosis in an Open Reference Center for Low-Income Population[J].J Neurosci Rural Pract,2018,9(4):516-521.DOI:10.4103/jnrp.jnrp_106_18.
• [10] YUAN S M.S100 and S100β:biomarkers of cerebral damage in cardiac surgery with or without the use of cardiopulmonary bypass[J].Rev Bras Cir Cardiovasc,2014,29(4):630-641.DOI:10.5935/1678-9741.20140084.
• [11] MAO Q,CHEN J,LI N,et al.The value of serum myelin basic protein in assessment of severity of acute closed head trauma[J].Hua Xi Yi Ke Da Xue Xue Bao,1995,26(2):135-137.
• [12] 柯俊吉,王建平.红细胞分布宽度对急性脑梗死患者近期预后的预测价值[J].中国实用神经疾病杂志,2018,21(3):253-257.
• [13] THOMAS D G,PALFREYMAN J W,RATCLIFFE J G.Serum-myelin-basic-protein assay in diagnosis and prognosis of patients with head injury[J].Lancet,1978,1(8056):113-115.DOI:10.1016/s0140-6736(78)90415-4.
• [14] LIU Q,LI H,YANG J,et al.Valproic acid attenuates inflammation of optic nerve and apoptosis of retinal ganglion cells in a rat model of optic neuritis[J].Biomed Pharmacother,2017,96:1363-1370.DOI:10.1016/j.biopha.2017.11.066.
• [15] FINK E L,BERGER R P,CLARK R S,et al.Serum biomarkers of brain injury to classify outcome after pediatric cardiac arrest[J].Crit Care Med,2014,42(3):664-674.DOI:10.1097/01.ccm.0000435668.53188.80.
• [16] THOMAS D G,RABOW L,TEASDALE G.Serum myelin basic protein,clinical responsiveness,and outcome of severe head injury[J].Acta Neurochir Suppl (Wien),1979,28(1):93-95.DOI:10.1007/978-3-7091-4088-8_20.
• [17] MENASCU S,BREZNER A,TSHECHMER S M,et al.Serum biochemical markers for brain damage in children with emphasis on mild head injury[J].Pediatr Neurosurg,2010,46(2):82-88.DOI:10.1159/000319004.
• [18] NEHER M D,KEENE C N,RICH M C,et al.Serum biomarkers for traumatic brain injury[J].South Med J,2014,107(4):248-255.DOI:10.1097/SMJ.00000000 00000086.
• [19] MEHTA T,FAYYAZ M,GILER G E,et al.Current Trends in Biomarkers for Traumatic Brain Injury[J].Open Access J Neurol Neurosurg,2020,12(4):86-94.
• [20] MORRIS M C,BERCZ A,NIZIOLEK G M,et al.UCH-L1 is a Poor Serum Biomarker of Murine Traumatic Brain Injury After Polytrauma[J].J Surg Res,2019,244:63-68.DOI:10.1016/j.jss.2019.06.023.
• [21] AGOSTON D V,KAMNAKSH A.Protein biomarkers of epileptogenicity after traumatic brain injury[J].Neurobiol Dis,2019,123:59-68.DOI:10.1016/j.nbd.2018.07.017.
• [22] SALVAGNO G L,SANCHIS-GOMAR F,PICANZA A,et al.Red blood cell distribution width:A simple parameter with multiple clinical applications[J].Crit Rev Clin Lab Sci,2015,52(2):86-105.DOI:10.3109/10408363.2014.992064.
• [23] BITEKER F S,?ZLEK B,?ZLEK E,et al.Red blood cell distribution width in sepsis[J].Am J Emerg Med,2018,36(9):1695-1696.DOI:10.1016/j.ajem.2018.01.024.
• [24] THAM T,BARDASH Y,TEEGALA S,et al.The red cell distribution width as a prognostic indicator in upper aerodigestive tract (UADT) cancer:A systematic review and meta-analysis[J].Am J Otolaryngol,2018,39(4):453-458.DOI:10.1016/j.amjoto.2018.04.013.
• [25] BAZICK H S,CHANG D,MAHADEVAPPA K,et al.Red cell distribution width and all-cause mortality in critically ill patients[J].Crit Care Med,2011,39(8):1913-1921.DOI:10.1097/CCM.0b013e31821b85c6.
• [26] QIAN H,LUO Z,XIAO C,et al.Red cell distribution width in coronary heart disease:prediction of restenosis and its relationship with inflammatory markers and lipids[J].Postgrad Med J,2018,94(1115):489-494.DOI:10.1136/postgradmedj-2018-135806.
• [27] ALCAíNO H,POZO J,PAVEZ M,et al.Red cell distribution width as a risk marker in patients with cardiovascular diseases[J].Rev Med Chil,2016,144(5):634-642.DOI:10.4067/S0034-98872016000500012.
• [28] MARTINEZ C,MOONEY C T,SHIEL R E,et al.Evaluation of red blood cell distribution width in dogs with various illnesses[J].Can Vet J,2019,60(9):964-971.
• [29] KOZANHAN B,IYISOY M S.Red cell distribution width as a novel predictor of postoperative respiratory adverse events after adenotonsillectomy[J].Paediatr Anaesth,2017,27(6):609-615.DOI:10.1111/pan.13138.
• [30] 王长福,王斌杰,王智,等.磁共振多模态成像及融合技术在脑胶质瘤术后放疗剂量优化中的应用[J].中国实用神经疾病杂志,2019,22(11):1179-1185.DOI:10.12083/SYSJ.2019.11.160.
• [31] ANTONUCCI E,GIOVINI M.Red cell distribution width in transfused critically ill patients:are we ready for this?[J].Minerva Anestesiol,2019,85(11):1147-1148.DOI:10.23736/S0375-9393.19.13894-1.
• [32] HUNZIKER S,STEVENS J,HOWELL M D.Red cell distribution width and mortality in newly hospitalized patients[J].Am J Med,2012,125(3):283-291.DOI:10.1016/j.amjmed.2011.08.021.
• [33] DESAI S A,MARTIN S L,NANAVATI R N,et al.Red Cell Distribution Width (RDW):Normative Data in Indian Neonates[J].J Pediatr Hematol Oncol,2019,41(2):e119-e121.DOI:10.1097/MPH.0000000000 001164.
• [34] BUTTARELLO M.Laboratory diagnosis of anemia:are the old and new red cell parameters useful in classification and treatment,how?[J].Int J Lab Hematol,2016,38(Suppl 1):123-132.DOI:10.1111/ijlh.12500.
• [35] MARTIN S L,DESAI S,NANAVATI R,et al.Red cell distribution width and its association with mortality in neonatal sepsis[J].J Matern Fetal Neonatal Med,2019,32(12):1925-1930.DOI:10.1080/14767058.2017.1421932.