A Study Of Laboratory Diagnosis And Clinical Application On Serum S100B In Hepatic Encephalopathy

Hepatic encephalopathy is a serious neuropsychiatric complication ofchronic or acute liver failure or portosystemic bypass. Symptoms of this diseaseencompass a broad spectrum of neuropsychiatric manifestations of varyingseverity: patients may have metabolism disorders and exhibit alterations inintellence, emotion, consciousness, psychomotor and fine motor functions. Anearly diagnosis of HE is beneficial for reducing mortality and neurologicalcomplications, however, The precise marker for HE has not been establishednow. Serum S100B is crucial for the diagnosis of HE in research setting, whichhas been proved useful for the pathogenesis,diagnosis and prognosis of HE,although it require further validation in clinical trials.Objective:To detect serum S100B, ammonia and Na, Cl level in differentgroups.To evaluate the sensitivity, specificity, and the positive and negativepredictive value of these biomarkers with ROC and cross-tabs analyses.Toobserve the relationship between serum S100B levels and the clinicalefficacy.To analyze serum S100B and ammonia levels correlate with theetiology type and various grades of HE.To speculate on the correlation of serumS100B and ammonia.To understand the role of serum S100B and ammonia forthe diagnosis of hepatic encephalopathy disease in depth and provide the clinical application value of serum S100B in the diagnosis of HE.Method: Records of97patients with hepatopathy diagnosed(52HE and45non-HE) in the First Hospital of Jilin University between May2011andDecember2012and50healthy individuals were reviewed. Serum S100B andammonia were detected by enzyme-linked immunosorbent assay (ELISA) andglutamate dehydrogenase assay respectively. Na+and Cl-were measured byselective electrode method.Results:1. Levels of serum S100B, ammonia and Na, Cl are different in differentgroups:Serum S100B and ammonia were increased significantly in hepaticencephalopathy patients compared to non-hepatic encephalopathy group (P＜0.05); Na, Cl is lower than non-hepatic encephalopathy group (P＜0.05).2. Sensitivity, specificity and predictive value of serum S100B andammonia:(1) The cut-off of serum S100B and ammonia were0.325ng/mL,158.5μmol/L respectively.(2)Sensitivity and specificity of serum S100B andammonia were71.2%,84.0%and76.9%,71.1%, respectively. Combination ofserum S100B and ammonia offered high sensitivity (84.0%) and specificity(76.9%)(P <0.05).3. Serum S100B levels correlate with clinical efficacy of HE: SerumS100B was already significantly decreased at3to5days,7to9days aftertreatment (P＜0.05).4. Serum S100B and ammonia levels correlate with the etiology type, various grades of HE: A significant difference concerning S100B and ammonialevels were observed among various grades of HE and every two gradesshowed a significant difference(P＜0.05). A significant difference was found inammonia levels between B-type portosystemic bypass and C-type cirrhoticchronic of HE(P＜0.05), but not with the A-type of acute liver failure of HE.The S100B have no significant difference among the etiology type of hepaticencephalopathy.5. The relationship between serum S100B and ammonia: Serum S100Bwas positively correlated with ammonia (r=0.729，P＜0.05), but the correlationcoefficient is not significantly. The cases are limited, so it may have a certaininfluence on the results. we will expand the sample size for further research.Conclusion:1. The cut-off of the Serum S100B in hepatic encephalopathy andnon-hepatic encephalopathy were0.325ng/mL、158.5μmol/L. Also, SerumS100B has a high degree of specificity.2. Serum S100B levels wered correlated with clinical efficacy of HE,which could be used to evaluate clinical efficacy.3.Serum S100B and ammonia levels were correlated with the etiologytype and various grades of HE, a significant difference was found in ammonialevels between B-type portosystemic bypass and C-type cirrhotic chronic ofHE(P＜0.05), but not with the A-type of acute liver failure of HE. It wouldcontribute to the diagnosis and prognosis of hepatic encephalopathy. 4Serum S100B has a high degree of specificity while the sensitivity ofammonia is higher. Serum S100B was positively correlated with ammonia, butthe correlation coefficient is not significantly.