The Effect Of Edaravone On The Patients Of Moderate Craniocerebral Injured And Severe Craniocerebral Injured Patients Serum Neuron-specific Enolase And S100B Protein

Abstract:Objective:This study is to appraise the effect of edaravone on moderate craniocerebral injured and severe craniocerebral injured patients by observing the change of the serum neuron-specific enolase(NSE) and S100B protein (S100B) after using edaravone.Method: 1. Choose the patients of acute moderate craniocerebral injury and severe craniocerebral injury who were emergently admitted to Department of Neurosurgery of Affiliated Hospital of Luzhou Medical College between March 2009 and March 2010 as the treatment group.62 male cases and 28 female cases,the ages are from 18 to 72 and the average age is 42.2.Selection criteria as follows:(1)Having absolute history of craniocerebral injury without other severe systematic injuries and admission to hospital within 4-8 hours after injury.(2)Older than 17 and they were Healthy before injury.(3)Glasgow coma scal:3'～12'.To admission were abnormal findings in CT of head,showed the main type of traumatic brain injury is cerebral contusion and laceration accompanied or intracerebral hematoma or subdural hematoma, with or without epidural hematoma,skull fracture.(4)All patients had emergency craniotomy within 12 hours after injury.There are 57 cases of moderate craniocerebral injury(GCS:9'-12'),33 cases of severe craniocerebral injury(GCS:3'-8').CT of head is showed cerebral contusion and laceration accompanied or intracerebral hematoma or subdural hematoma,there are 45cases of cerebral contusion and laceration accompanied,24 cases intracerebral hematoma,21 cases subdural hematoma,with or without epidural hematoma,skull fracture.90 cases of traumatic brain injury (TBI) were randomly divided into 3 groups:the normal treat group(A group),the postoperative application of edaravone treat group (B group) and the pre-operative application of edaravone treat group(C group),which 30 cases each group.19 cases of the normal treat group(A group) are moderate craniocerebral injury and 11 case are severe craniocerebral injury,20 cases of the postoperative application of edaravone treat group (B group) are moderate craniocerebral injury and 10 case are severe craniocerebral injury,18 cases of the pre-operative application of edaravone treat group(C group) are moderate craniocerebral injury and 12 case are severe craniocerebral injury.All cases underwent emergency craniotomy,to remove inactivation of brain tissue and/or intracerebral hematoma, some cases increase decompressive craniectomy.All cases received the drug treatment at least 8d,the treatment programs such as the following:the normal treat group(A group):limited to the conventional treatment before and after surgery,treating with dehydration to decrease cranial pressure,resisting infection as well as curing symptom and sustaining;the postoperative of edaravone treat group(B group):treating with edaravone 30mg infusion on the base of normal treatment after surgery twice a day for 7 days;the pre-operative application of edaravone treat group(C group):treating with edaravone 30mg infusion on the base of the normal treat group on the sacrificing blood sample after admission once and treating with edaravone 30mg infusion after surgery once,after that treating with the B group.Take 20 simultaneous outpatients without other systematic diseases as the healthy control group.2.By enzyme-linked immunosorbent assay (ELISA),the concentration of serum NSE and S100B was detected in series,and the relationships between alteration of serum NSE and S100B and brain injury were investigated in patients with the normal treat group(A group),the postoperative application of edaravone treat group(B group) and the pre-operative application of edaravone treat group(C group) respectively.The serum NSE and S100B of 90 patients with TB1 was determined serially on admission,on 1d,3d,5d and 7d after postoperative.To investigat The variational patterns of NSE and S100B.The serum NSE and S100B of 20 simultaneous outpatients without other systematic diseases was also measured one time.Serum NSE and S100B with enzyme-linked immunosorbent assay (ELISA) method.3.All the data were analyzed with the statistics software SPSS13.0.Measurement data represents as x±S,Between-group comparison of measurement data using One-factor analysis of variance and T-test with significance level P<0.05,rating information usingχ2-test.Compared C group,B group with A group and C group with B group.Results:The serum NSE and S100B protein level in the healthy group was(8.46±1.05)μg/l and(0.38±0.10)μg/l.The serum NSE and S100B protein level in A group,B group and C group step up on admission,then get to the top value within 1day after postoperative,them was higher than that of the healthy group on admission, on 1d,3d,5d and 7d after postoperative (P<0.01). Between-group comparison of A group,B group and C group had no statistical difference to that of A group on admission (P>0.05).The serum NSE and S100B levels of A group,B group and C group were remarkably elevated and reached peak value within 1day after postoperative,and then gradually decreased,The levels of serum NSE and S100B protein in moderate craniocerebral injury and severe craniocerebral injury of C group is lower than that in A group or B group on 1d after postoperative (P<0.05).The serum NSE and S100B protein levels in moderate craniocerebral injury and severe craniocerebral injury of B group had no statistical difference to that of A group on 1d after postoperative(P>0.05).The serum NSE and S100B protein levels in moderate craniocerebral injury and severe craniocerebral injury of C group were lower than that of A group on 3d,5d and 7d after postoperative(P≤0.02).The serum NSE and S100B protein Measurement levels in moderate craniocerebral injury of C group were lower than that of B group, but there is no statistical difference to that of B group on 3d,5d and 7d after postoperative.The serum NSE and S100B protein levels in severe craniocerebral injury of C group were lower than that of B group on3d,5d and 7d after postoperative(P<0.05).The serum NSE and S100B protein levels in moderate craniocerebral injury and severe craniocerebral injury of B group were lower than that of A group on 3d,5d and 7d after postoperative(P<0.05).Conclusions:(1)The serum NSE and S100B protein levels becomes higher with the change of the severity of the disease,the levels is a sensitive marker of brain injury in acute phase of TBI;(2)It means neurons and glia cells were injured and the serum NSE and S100B levels were higher than the normal value on admission, on 1d,3d,5d and 7d after postoperative;(3)Edaravone can lower the serum NSE and S100B protein levels in moderate craniocerebral injured and severe craniocerebral injured patients after surgery,The serum NSE and S100B protein levels becomes lower with the earlier use of edaravone.Especially, the pre-operative application of edaravone can lower the serum NSE and S100B protein levels in severe craniocerebral injured patients after surgery.