脑出血患者血浆和脑脊液阿片肽含量的变化及纳络酮的干预作用

Change of opioid peptide content in plasma and CSF of patients with cerebral hemorrhage and interference effect of Naloxone

目的探讨脑出血患者血浆和脑脊液(CSF)阿片肽———β内啡肽(βEP)、强啡肽A113(DynA113)的含量变化及纳络酮的干预作用。方法将60例脑出血患者随机分为纳络酮组和对照组;两组在脑出血常规治疗的基础上,纳络酮组加用纳络酮3.0mg静脉滴注,每日1次,连用14d。采用放射免疫分析法(RIA)检测两组患者治疗前和治疗7d、14d血浆和CSF中βEP、DynA113的含量,分析脑出血部位及出血量与上述指标变化的关系并与正常组(正常血浆组及正常CSF组)比较;对两组脑出血患者治疗前后格拉斯哥昏迷评分(GCS)和神经功能缺损程度评分(NDS)进行比较。结果(1)脑出血患者血浆和CSF中βEP、DynA113含量与两正常组比较明显增高(均P<0.01);不同出血部位患者的血浆和CSF中βEP、DynA113含量的差异无显著性;脑出血量与血浆和CSF中βEP、DynA113含量呈显著正相关(r=0.663、0.480、0.645、0.380,均P<0.01);(2)治疗后纳络酮组血浆和CSF中βEP、DynA113含量明显低于对照组(P<0.05～0.01);GCS、NDS较对照组明显改善(均P<0.05)。结论脑出血后血浆和CSF中阿片肽含量异常升高;纳络酮治疗能明显降低血浆及CSF中阿片肽含量,显著改善脑出血患者的神经功能缺损。

Objective To explore the change of opioid peptide content such as β-endorphin （β-EP）,dynorphinA1-13（DynA1-13） in plasma and eerebrospinal fluid （CSF） of patients with cerebral hemorrhage, and the interferenee effect of Naloxone on them. Methods 60 patients with cerebral hemorrhage were randomly divided into Naloxone-treated group and control group. C.nventional treatment was used in both groups, then Naloxone-treated group intravenous drip of Naloxone, each 3.0mg, once a day, for 14 d. The concentrations of β-EP, DynA1-13 of the patients were measured with radioimmunoassay （RIA） during the acute stage before treatment and at 7th, 14th day after treatment compared with those of normal group （the normal people and the patients were treated by operations）. Changes of β-EP and DynA1-13 in bleeding part and amount of hleeding were analyzed. The scores of GCS and NDS betore and after treatment were .examined at the same time. Results （1） The content of β-EP, DynA1-13 in plasma and CSF of patients with cerebral hemorrhage were obviously higher since acute stage than those of the normal group （ all P 〈0. 01） ;the content of β-EP, DynA1-13 in plasma and CSF of patients with varied parts hemorrhage were not significantly remarkable; positive correlation between the amount bleeding and the content of β-EP, DynA1-13 in plasma and CSF were revealed （r=0,663, 0.480, 0.645, 0.380,all P〈0.01）. （2） The content of β-EP, DynA1-13 is in plasma amt CSF of Naloxone-treated group were significantly lower than those of control group（ P〈0. 05-0.01） ;and at 7th day after treatment, the scores of GCS and GCS improve significantly than that of control group（ all P〈0.05）. Conclusions The content of opioid peptide in plasma and CSF obviously increase immediately after intracerebral hemorrhage. Naloxone can ameliorate significantly neurological dysfunction of the patients with cerebral hemorrhage.