神经元特异性烯醇化酶的动态变化在急性脑梗死患者中的临床意义

The clinical significance of neuron-specific enolasein serially determinated on the patients with acute cerebral infarction

目的 动态观察急性脑梗死患者血浆中神经元特异性烯醇化酶 (neuron- specific enolase,NSE)的变化 ,探讨其与脑梗死体积、神经功能缺损程度、梗死部位以及患者年龄、性别等方面相关性。方法 该实验采用酶联免疫吸附法 (enzym e- linked imm unosorbent assay,EL ISA)对 5 0例急性脑梗死患者的血浆 NSE水平进行动态检测 ,并与 30例对照组患者进行比较 ,同时应用 NIHSS进行神经功能缺损评分及 CT扫描测定梗死体积 ,并应用SPSS11.5统计软件包进行统计学分析。结果 急性脑梗死患者 NSE浓度在发病早期明显升高 ,1～ 3d达到峰值 ,明显高于恢复期及对照组 ,有严重神经功能缺失的患者 NSE升高更明显 ,NSE>2 5 .0μg/ L、NIHSS>12分均提示患者预后不良 ;NSE的血浆浓度与梗死体积呈显著正相关 (P<0 .0 1) ,与神经功能缺损程度也呈显著正相关 (P<0 .0 1)。结论 缺血性脑梗死后血浆中 NSE的出现与神经元坏死有关 ,并通过受损的血脑屏障进入血液 ,NSE可作为缺血性脑损伤尤其是大面积脑梗死早期的外周标志物 ,对指导治疗有帮助。

Objective To evaluate the significance of neuron-specific enolase concentration in plasma of patient with acute cerebral infarction and find the correlation with neurologic deficits,infarct volume and infarct spot,also with sex and age. Methods NSE levels in plasma were serially determined in 50 patients with ACI and in 30 control subjects. Assays were performed by ELISA. The neurological status was evaluated by the National Institutes of Health Stroke Scale(NIHSS) and the cranial computed tomography(CCT) also serially performed to calculate infarct volume. Comparison analyse were performed by a SPSS 11.5 statistical package. Results The concentrations of NSE were higher in patients with ACI;and peaked at 3rd day after stroke;the NSE concentrations in plasma were significantly higher in patients with severe neurological deficits at adimission. When NSE>25.0μg/L or NIHSS>12 point indicating poor outcome;The release of NSE in patients were associated with the volume of brain lesions (P< 0.01) and the neurological outcome as assessed by NIHSS (P< 0.01). Conclusion Presence of NSE in plasma after ischemic stroke may be due to combined leakage out of neuron and passage through an impaired brain-blood barrier,indicating severe ischemic cell injury,therefore NSE in plasma can be used as a peripheral marker of ischemic focal brian damage especial of big size of brain lesion,may be helpful for therapeutic decisions in acute ischemic stroke.