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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 541 -545. doi: 10.3877/cma.j.issn.1674-0785.2022.06.014

临床研究

外源性脑损伤患者血清GFAP、PGP9.5表达联合CT诊断的临床价值研究
杨宝军1,†(), 李玲玲1, 郭丽娟1, 周楠1, 王程燕1, 张香玲1   
  1. 1. 030600　山西晋中，晋中市第一人民医院核医学科
  • 收稿日期:2021-08-31 出版日期:2022-06-15
  • 通信作者: 杨宝军

Clinical value of serum GFAP and PGP9.5 combined with CT in diagnosis of patients with exogenous brain injury

Baojun Yang1,†(), Lingling Li1, Lijuan Guo1, Nan Zhou1, Chengyan Wang1, Xiangling Zhang1   

  1. 1. Department of Nuclear Medicine, Jinzhong First People's Hospital, Jinzhong 030600, China
  • Received:2021-08-31 Published:2022-06-15
  • Corresponding author: Baojun Yang
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杨宝军, 李玲玲, 郭丽娟, 周楠, 王程燕, 张香玲. 外源性脑损伤患者血清GFAP、PGP9.5表达联合CT诊断的临床价值研究[J]. 中华临床医师杂志(电子版), 2022, 16(06): 541-545.

Baojun Yang, Lingling Li, Lijuan Guo, Nan Zhou, Chengyan Wang, Xiangling Zhang. Clinical value of serum GFAP and PGP9.5 combined with CT in diagnosis of patients with exogenous brain injury[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(06): 541-545.

目的

研究血清中胶质纤维酸性蛋白（GFAP）、脑特异性蛋白产物（PGP9.5）联合颅脑CT在外源性脑损伤诊断中的临床价值。

方法

在晋中市第一人民医院2021年5月至2021年10月收治的脑损伤患者中随机选取251例，检测所有患者的血清GFAP、PGP9.5、中枢神经特异性蛋白（S100β）和神经元特异性烯醇化酶（NSE）水平，并对所有患者行颅脑CT检查，对比各项检查结果。

结果

血清GFAP检测阳性有90例（35.857%），范围在22.723~303.949（124.887±56.396）pg/ml，阴性范围为4.317~21.953（12.996±5.243）pg/ml；血清PGP9.5检测阳性有81例（32.271%），范围为335.180~2321.709（841.986±421.204）pg/ml，阴性范围为30.726~318.667（164.034±34.256）pg/ml；S100β阳性196例（78.09%），范围在0.262~3.520（1.952±0.224）ng/ml，阴性范围为0.021~0.089（0.046±0.008）ng/ml；NSE阳性193例（76.89%），范围在19.085~29.241（25.721±0.512）ng/ml，颅脑CT结果显示有病变者为178例（70.92%），无异常者有73例（29.08%）。轻度、中度、重度三组患者其血清GFAP、PGP9.5、S100β、NSE水平对比差异具有统计学意义（P＜0.05）。109例外源性脑损伤病例GFAP阳性结果90例（82.57%），PGP9.5阳性结果81例（74.31%），S100β阳性结果83例（76.15%），NSE阳性结果111例（75.23%）。三种检查联合应用最高，为96.33%。

结论

在诊断阳性率基本相当的情况下，GFAP和PGP9.5对外源性脑损伤的诊断比S100β和NSE具有更高的特异性，在对外源性脑损伤的诊断中应用颅脑CT联合血清GFAP、PGP9.5检测的诊断准确性更高，更能帮助临床进行后续治疗。

关键词: 血清GFAP, 血清PGP9.5, 外源性脑损伤, 颅脑CT
Objective

To assess the clinical value of serum collagen fibrillary acidic protein (GFAP) and brain specific protein product (PGP9.5) combined with craniocerebral CT in the diagnosis of exogenous brain injury.

Methods

A total of 251 patients with brain injury admitted to The First People's Hospital of Jinzhong from May 2021 to October 2021 were randomly selected. The levels of serum GFAP, PGP9.5, central nervous specific protein (S100β), and neuron specific enolase (NSE) in all patients were detected, brain CT examination was performed on all patients, and the results were compared.

Results

Ninety patients (35.857%) were positive for GFAP [range, 22.723~303.949 pg/ml; mean, (124.887±56.396) pg/ml], and those who were negative for GFAP had GFAP levels ranging from 4.317~21.953 (12.996±5.243) pg/ml; 81 patients (32.271%) were positive for PGP9.5 [range, 335.180~2321.709; mean, (841.986±421.204) pg/ml), and those who were negative for PGP9.5 had PGP9.5 levels ranging from 30.726~318.667 (164.034±34.256) pg/ml; 196 patients (78.09%) were positive for S100β [range, 0.262~3.520 ng/ml; mean, (1.952±0.224) ng/ml], and those who were negative for S100β had S100β levels ranging from 0.021~0.089 (0.046±0.008) ng/ml; and 193 patients (76.89%) were positive for NSE [range, 19.085~29.241 ng/ml; mean, (25.721±0.512) ng/ml]. Brain CT showed lesions in 178 cases (70.92%) and no abnormality in 73 (29.08%). There were statistically significant differences in serum GFAP, PGP9.5, S100β, and NSE levels among the mild, moderate, and severe groups (P＜0.05). Among 109 cases with exogenous brain injury, 90 (82.57%) were positive for GFAP, 81 (74.31%) for PGP9.5, 83(76.15%) for S100β, and 111 (75.23%) for NSE. The diagnostic accuracy of the three tests combined was 96.33%.

Conclusion

Serum GFAP and PGP9.5 have higher specificity than S100β and NSE in the diagnosis of exogenous brain injury under the condition that the positive rate of diagnosis is basically the same. The application of brain CT combined with serum GFAP and PGP9.5 in the diagnosis of exogenous brain injury has higher diagnostic accuracy and is more helpful for clinical follow-up treatment.

Key words: Serum GFAP, Serum PGP9.5, Exogenous brain injury, Craniocerebral CT
表1 血清检测结果
检测项目 范围（平均值） 阳性率
GFAP（pg/ml）
阳性（90例） 22.723~303.949（124.887±56.396） 35.86%（90/251）
阴性（161例） 4.317~21.953（12.996±5.243）
PGP9.5（pg/ml）
阳性（81例） 335.180~2321.709（841.986±421.204） 32.27%（81/251）
阴性（170例） 30.726~318.667（164.034±34.256）
S100β（ng/ml）
阳性（196例） 0.262~3.520（1.952±0.224） 78.09%（196/251）
阴性（55例） 0.021~0.089（0.046±0.008）
NSE（ng/ml）
阳性（193例） 8.021~13.014（10.521±0.825） 76.89%（193/251）
阴性（58例） 19.085~29.241（25.721±0.512）
表2 不同程度脑损伤患者血清检测结果对比（
xˉ
±s）
组别 GFAP（pg/ml） PGP9.5（pg/ml） S100β NSE
轻度（96例） 56.24±5.24 757.52±26.54 0.196±0.012 6.521±1.025
中度（85例） 135.52±16.51 1265.21±85.25 1.235±0.164 10.021±1.532
重度（70例） 263.52±20.20 2140.25±135.10 3.021±0.241 16.321±2.151
F值 4028 4976 6404 789.6
P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001
表3 诊断准确率
检测项目 检出阳性率
血清GFAP 82.57（90/109）
血清PGP9.5 74.31（81/109）
颅脑CT 85.32（93/109）
GFAP、PGP9.5、CT三项联合 96.33（105/109）
S100β 76.15（83/109）
NSE 75.23（82/109）
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