摘要： 目的 探讨急性颅脑创伤患者血清和脑脊液神经元特异性烯醇化酶表达变化与病情严重程度和预后关系。方法 共89例急性颅脑创伤患者根据入院时Glasgow 昏迷量表（GCS）评分分为轻型、中型、重型和特重型颅脑创伤组，于伤后12 h 内分别检测血清（89 例）和脑脊液（18 例）神经元特异性烯醇化酶表达水平，Spearman 秩相关分析评价其与颅脑创伤程度和预后的相关性。结果 与对照组相比，颅脑创伤各组患者血清神经元特异性烯醇化酶表达水平升高（均P < 0.05），且特重型组和重型组高于中型组和轻型组（均P < 0.05）。脑挫裂伤患者血清神经元特异性烯醇化酶表达水平高于弥漫性轴索损伤（P = 0.025）、硬膜下血肿（P = 0.031）和硬膜外血肿患者（P = 0.021）。血清神经元特异性烯醇化酶表达水平与GCS 评分（r_s = - 0.327，P = 0.024）和Glasgow 预后分级评分（r_s = - 0.252，P = 0.049）均呈负相关关系。特重型和重型颅脑创伤患者脑脊液神经元特异性烯醇化酶表达水平均高于血清（P = 0.039，0.031）。结论 神经元特异性烯醇化酶表达变化可以作为辅助评价急性颅脑创伤程度、分型诊断和判断预后的实验室指标，且脑脊液神经元特异性烯醇化酶水平较血清更敏感。

关键词: 磷酸丙酮酸水合酶, 脑损伤, 预后

Abstract: Objective  To investigate the relationship between neuron-specific enolase (NSE) levels in serum and cerebrospinal fluid (CSF) of patients with acute traumatic brain injury (TBI) and the prognosis of TBI patients.  Methods  A total of 89 patients with acute TBI were divided into light, medium, heavy and severe TBI groups based on admission Glasgow Coma Scale (GCS) score. Serum NSE expression levels were detected in all cases and NSE levels in CSF were detected in 18 cases within 12 h after TBI. The expression levels of serum NSE in 20 normal people, except cases of lung disease and nervous system damage, were detected as a control group. Results  Compared with the control group, serum NSE expression levels of patients in each TBI group were elevated (P < 0.05, for all), and the NSE levels in severe and heavy TBI groups were higher than that in medium and light groups (P < 0.05, for all). The serum NSE expression levels of patients with cerebral contusion were higher than that of patients with diffuse axonal injury (DAI, P = 0.025), subdural hematoma (P = 0.031) and epidural hematoma (P = 0.021). Serum NSE expression levels were negatively correlated with GCS score (r_s = - 0.327, P = 0.024) and Glasgow Outcome Scale (GOS) score (r_s = - 0.252, P = 0.049). The NSE expression levels of CSF in severe and heavy TBI patients were higher than that of serum (P = 0.039, 0.031).  Conclusions  NSE expression changes can be evaluated as an auxiliary indicator in reflecting the degree of acute TBI, typing diagnosis and prognostic evaluation, and NSE levels of CSF is more sensitive than that of serum.

Key words: Phosphopyruvate hydratase, Brain injuries, Prognosis