急性脑出血患者血清炎性递质水平与预后分析

Level of serum inflammatory mediators and the prognosis in patients with spontaneous intracerebral hemorrhage

目的:观察急性脑出血患者血清炎性递质及其他临床和实验室因素对患者早期预后的影响。方法:对2003-01/2004-01解放军第三军医大学大坪医院野战外科研究所神经内科住院的42例急性脑出血患者抽静脉血4mL分别进行血清肿瘤坏死因子-α、白细胞介素-1β、P-选择素及S-100蛋白检测;头颅CT检查计算脑出血量;采用卒中量表对病情严重程度及神经功能缺失程度进行评分(30d后患者分数较入院时下降者好转,分数增高、无变化及死亡者为恶化),对脑出血30d预后影响因素进行单因素和多因素分析。结果:42例患者全部进入结果分析。①42例急性脑出血患者在入院30d时好转22例,未好转20例。单因素分析显示,未好转组入院时神经功能缺损评分、脑出血量、入院时血清肿瘤坏死因子-α、白细胞介素-1β、P-选择素、S-100蛋白水平均显著高于好转组犤(30.4±5.5),(22.9±6.1)分;(28.1±7.1),(18.0±7.1)mL;(1.06±0.15),(0.92±0.14)ng/L;(3.91±0.76),(3.40±0.51)ng/L;(421.8±145.2),(275.7±115.1)μg/L;(1.46±0.16),(1.26±0.14)mg/L,(P<0.01)犦。②多因素分析显示入院时神经功能缺损评分为影响本组脑出血患者预后的独立预测因素(OR=3.694,95%CI1.670～8.173,P=0.001)。结论:急性脑出血患者中神经功能缺损程度评分显示未好转者入院时血清炎性递质肿瘤坏死因子-α、白细胞介素-1β、P-选择素及S-100蛋白水平较高,可能为高血压脑出血患者早期预后的预测因素之一。

AIM： To investigate the effects of level of serum inflammatory mediators and some clinical, laboratory parameters on early prognosis in the patients with spontaneous intracerebral hemorrhage（ICH）. METHODS： Venous blood 4 mL from 42 inpatients with spontaneous ICH hospitalized in the Department of Neurology, Research Institute of Surgery, Daping Hospital, Third Military Medical University between January 2003 and January 2004 were collected for the measurement of tumor necrosisalpha（TNF-α）, interleukin-1β（IL-1β）, P-selectin and S-100 protein（S-100） levels. The volumes of ICH were measured on CT scan. Stroke severity and neurologic outcome were evaluated with the Chinese Stroke Scale（CSS, At 30 days after hospitaliztion, if the score was decreased, the condition of patients was improved, and if the score was increased, unchanged or the patients died, the condition was worsened）. Single-factor or multi-factor analyses were performed for assessing the factors influencing prognosis at 30 days after ICH. RESULTS： All the 42 patients were analyzed in the result. ①In 42 patients with ICH, good outcome was recorded in 22 patients and poor outcome in 20 patients at 30 days. By single-factor analysis when admission, the CSS scores of neurologic impairment, the volume of ICH and the levels of TNF-α, IL-1β, P-selectin and S-100 were significantly higher in the group of patients with poor outcome than in the group of patients with good outcome[（30.4±5.5） marks, （28.1±7.1） mL, （1.06±0.15） ng/L, （3.91±0.76） ng/L, （421.8±145.2）μg,/L, （1.46±0.16） mg/L;（22.9±6.1） marks, （18.0±7.1） mL, （0.92±0.14） ng/L, （3.40±0.51） ng/L, （275.7±115.1）μg/L, （1.26±0.14） mg/L, P 〈 0.01].]②From multi-factor analysis, it was revealed that the admission CSS score of neurologie impairment was independently and significantly associated with prognosis at 30 days （OR=3.694, 95% CI 1.670 to 8.173, P=-0.001 ）. CONCLUSION： Shown by the score of neurologic impairment, the levels of inflammatory mediators-TNF-α, IL-1β, P-seleetin and S-100 were significantly increased in ICH patients with poor outcome as compared with those with good outcome. They may be main parameters that can predict the short-term prognosis of patients with ICH.