肝移植围手术期血浆S-100β和神经元特异性烯醇化酶的变化及与术后脑病的关系

摘要

Objective To observe the changes in plamsa S-100β and neuron-specific enolase(NSE)and to study their relationship with encephalopathy after orthotopic liver transplantation(OLT).Methods Thirty patients without neurological disease undergoing OLT were studied.Plamsa S-100β and NSE were examined at three time points:after induction of anesthesia(T1),at the end of operation(T2)and 24 hours after reperfusion of the transplant(T3).The difference of plamsa S-100β and NSE between encephalopathy group and non-encephalopathy group was analyzed. Results Eleven patients were complicated with encephalopathy after OLT.In 30 patients,S-100βat T2[(3.715±1.523)μg/L3 was higher than that at T1 ((1.478±0.809)μg/L,P＜0.01];S-100β at T3[(1.765±0.894)μg/L3 decreased to normal level(T1).NSE at T2[(26.684±7.973)μg/L3 was higher than that at T1[(14.012±4.612)μg/L,P＜0.013.At T3,the level of plamsa NSE[(18.105±7.345)pg/L3 was decreased,but higher than that at T1.Plamsa S-100β and NSE in encephalopathy group(11 cases)and non-encephalopathy group(19 cases)showed the same tendency of change as all of the patients.Plamsa S-100β at T3 in encephalopathy group[(2.007±0.854)μg/L3 was higher than that in non-encephalopathy group[(1.468±0.903)μg/L,P＜0.053,and it was correlated with the presence of encephalopathy(r=0.385,P=0.039),but not at T1 and T2.Plamsa NSE at three time points showed no relationship to the presence of encephalopathy.Conclusion The increase in plamsa S-100β and NSE during OLT indicates the occurrence of damage to the brain.But plamsa S-100β and NSE cannot predict encephalopathy after OLT.%目的 观察肝移植围手术期血浆S-10013和神经元特异性烯醇化酶(NSE)的变化,并分析其与术后脑病发生的关系.方法 选择行同种异体原位肝移植手术患者30例;于麻醉后(T1)、术毕时(T2)及新肝24 h(T3)经左侧颈内静脉导管取颈静脉球部血.采用酶联免疫吸附法(ELISA)检测S-100β和NSE浓度;并根据术后是否发生脑病分为脑病组和非脑病组,分析S-100β和NSE浓度与脑病发生的相关性.结果 30例患者S-100β浓度在T2时较T1时显著升高[(3.715±1.523)μg/L比(1.478±0.809)μg/L,P＜0.013,在T3时[(1.765±0.894)μg/L3下降接近T1水平;NSE浓度在T2时较T1时显著升高[(26.684±7.973)μg/L比(14.012±4.612)μg/L,P＜0.01],T3时C(18.105±7.345)μg/L3显著下降,但仍高于T1水平.脑病组(11例)和非脑病组(19例)患者S-1006、NSE浓度变化趋势与全体患者相同;脑病组T3时S-100β浓度高于非脑病组C(2.007±0.854)μg/L比(1.468±0.903)μg/L,P＜0.053,且S-100β与脑病发生相关(r=0.385,P=0.039),T1、T2时S-100β浓度与脑病无相关关系;3个时间点NSE浓度与脑病发生均无相关关系.结论 血浆S-1006和NSE水平在术毕时升高,提示在肝移植术中发生了脑损伤,但是监测S-1006和NSE均不能预测脑病的发生.