背景:CT、MRI和经颅多普勒等现代化的神经影像学技术对于脑梗死的定位和判断梗死体积有重要作用,目前尚缺乏更加简便易行的实验室检测手段。目的:观察急性脑梗死患者血清中S100-β含量与发病后脑梗死体积及预后的关系。设计:病例-对照观察。单位:山东大学山东省立医院神经内科。对象:选择2004-09/2005-08山东省立医院神经内科收治58例缺血性脑梗死患者为病例组,年龄36～86岁,平均(67.7±14.2)岁,男37例,女21例,均于出现症状24h内入组。纳入标准:诊断符合第2次全国脑血管病学术会议修订的诊断标准;全部患者均经头颅CT或磁共振等神经系统扫描检查证实符合脑梗死标准。排除标准:有脑血管病病史和/或遗留残疾。对照组50例为同期入院健康体检者,男32例,女18例,年龄43～89岁,平均(68±9)岁,2组间性别及年龄构成差异无显著性。方法:①病例组患者在入院当时及第1,2,3,4,6,10天各留取血液标本1次,对照组受试者仅在早晨空腹时留取血液标本1次。血清S100-β水平用ELISA方法测定。②病例组于患者脑梗死发作后第7天经CT及SimesSomatom所提供的软件测量梗死体积,神经功能于患者脑梗死发作后3个月评定,评定标准为修正的Rankin等级评分。主要观察指标:①两组受试者血清S100-β浓度。②病例组患者急性脑梗死发作后第7天时脑梗死体积以及脑梗死发作3个月后神经功能的评定。结果:纳入患者58例和正常对照者50例,除病例组中6例患者出现脑干反射完全消失后2月内死亡外,其余均进入结果分析。①病例组患者血清S100-β蛋白含量:逐渐增高,高峰在患者出现急性脑梗死症状后的第3天出现,为(0.61±0.13)μg/L,至第10天下降。经Post-hoc检验,脑梗死6天以内S100-β水平高于对照组,至第10天与对照组比较差异无显著性。②病例组患者血清S100-β水平:从发病开始的第1,2,3,4,6天(第10天除外)均与最终的脑梗死体积呈正相关,在第3天相关性最密切(r=0.937,P<0.01)。③病例组患者急性脑梗死3个月情况:以改良的Rankin等级评分评定其神经功能恢复情况,双变量相关分析显示血清S100-β水平与Rankin等级评分有密切的正相关性(r=0.507,P<0.001)。结论:血清中S100-β蛋白含量与急性脑梗死患者的脑梗死体积正相关,可以辅助预测急性脑梗死后神经功能恢复状况。 BACKGROUND: Modern neuroimaging techniques such as CT, MRI and transcranial Doppler have an important role in the localization of cerebral infarction and in the determination of infarct volume. At present, there is a lack of more simple and convenient laboratory tests. OBJECTIVE: To observe the relationship between S100-β in sera of patients with acute cerebral infarction and the volume and prognosis of cerebral infarction after onset. Design: Case-control observation. SETTING: Department of Neurology, Shandong Provincial Hospital, Shandong University. PARTICIPANTS: A total of 58 patients with ischemic stroke were enrolled in the Department of Neurology, Shandong Provincial Hospital from September 2004 to August 2005. The patients were 36 to 86 years old (mean 67.7 ± 14.2 years), 37 males and 21 females , Were within 24 hours of onset of symptoms into the group. Inclusion criteria: The diagnosis conformed to the revised diagnostic criteria of the 2nd National Cerebrovascular Disease Academic Conference; all patients were confirmed by cerebral CT scan or magnetic resonance imaging examination. Exclusion criteria: history of cerebrovascular disease and / or residual disability. The control group of 50 patients admitted for the same period of health examination, 32 males and 18 females, aged 43 to 89 years, mean (68 ± 9) years of age, gender and age differences between the two groups no significant difference. Methods: ① The patients in the case group were admitted to the hospital on the 1st, 2nd, 3rd, 4th, 6th and 10th days, respectively, and the control subjects received only one blood sample in the morning fasting. Serum S100-β levels were measured by ELISA. ② In the case group, the volume of infarction was measured by software provided by CT and Simesomatom on the 7th day after the onset of cerebral infarction. The neurological function was assessed at 3 months after the onset of cerebral infarction in patients with revised Rankin grade. MAIN OUTCOME MEASURES: ① Serum S100-β concentration in two groups of subjects. ② In the case group, the cerebral infarction volume at 7 days after the onset of acute cerebral infarction and the assessment of neurological function 3 months after the onset of cerebral infarction. Results: Fifty-eight patients were included in the study and 50 patients were normal controls. All the patients except the six patients in the case group died within two months after their brainstem reflex completely disappeared. (1) Serum S100-βprotein levels in patient group increased gradually, peaked at (0.61 ± 0.13) μg / L on the third day after symptoms of acute cerebral infarction, and decreased on the 10th day. Post-hoc test showed that the S100-β level within 6 days after cerebral infarction was higher than that of the control group. There was no significant difference between the 10th day and the control group. ② Serum levels of S100-β in case group patients were positively correlated with the final volume of cerebral infarction on the 1st, 2nd, 3rd, 4th and 6th days (except day 10), and were most closely related on the 3rd day r = 0.937, P <0.01). (3) The situation of acute cerebral infarction in case group at 3 months: The recovery of neurological function was evaluated by modified Rankin scale, and the bivariate correlation analysis showed that there was a close positive correlation between serum S100-β level and Rankin grade score (r = 0.507, P <0.001). Conclusion: The serum S100-β protein content is positively correlated with the volume of cerebral infarction in patients with acute cerebral infarction, which can be used to predict the recovery of neurological function after acute cerebral infarction.