血清胶质纤维酸性蛋白与急性脑梗死患者临床特点与预后的关系

Clinical Investigation of Serum Glial Fibrillary Acid Protein in Patients with Acute Cerebral Infarction

目的测定急性脑梗死患者外周血胶质纤维酸性蛋白(glial fibrill aryacidic protein,GFAP)的动态变化,探讨其与脑梗死灶面积、神经功能缺损程度(NIHSS评分)以及预后(Barthel指数)的关系。方法采用自建生物素-亲和素多层放大ELISA法检测急性脑梗死患者发病后48h内、第5天、第7天和第14天血清GFAP水平。所有患者在相应时间点进行NIHSS评分,并在出院时评价Barthel指数。结果所有患者的血清GFAP于发病48h内开始升高,显著高于对照组,差异有统计学意义(P=0.015),并随时间延长呈下降趋势,第7天恢复至正常水平(P=0.056),但在第14天出现反弹,并显著高于对照组,差异有统计学意义(P=0.027)。发病48h内和第5天,梗死灶面积较大组、中等组和较小组及对照组4者间差异有统计学意义(P=0.032,P=0.048)。有较大梗死灶患者组血清GFAP水平较高。第5天和第7天血清GFAP水平分别与相应时间的NIHSS评分呈显著负相关(P<0.05),与出院时Barthel指数呈显著正相关(P<0.05)。结论GFAP在急性脑梗死患者血液中表达明显增强,有望成为评估脑梗死患者病情和预后的指标。

Objective In patients with acute cerebral infarction serum glial fibrillary acidic protein（GFAP） level and its temple profde was determined to investigate the relationship between GFAP level and the size of brain lesions, neurological status（NIHSS） and functional outcome （Barthel Index, BI ）. Methods Self-established biotin-avidin multi-layers magnifying solid phase enzyme immunoassay was used to determine serum GFAP level in patients with acute cerebral infarction at the time of 48 h, the fifth day, the seventh day and the fourtheen day after onset of stroke. All patients＇ neurological status was evaluated by the National Institutes of Health Stroke Scale （NIHSS） at corresponding time points, and functional outcome was evaluated by BI at discharge from the hospital. Results For all patients observed, serum GFAP level increased markedly compared to that of control group at the time of 48 h after onset of stroke （P = 0.015 ）. With time elapsing, it decreased, and restored to normal level at the seventh day（ P = 0.056 ）, but increased again at the fourteen day compared to that of control group（P =0.027） . There was significant difference for serum GFAP levels among patients with larger, middle, smaller size of brain lesion and normal control group at 48 h and the fifth day respectively after onset of stroke（ P = 0.032, P = 0.048）. Patients with larger size of brain lesion have relatively higher level of serum GFAP. There was significant linear negative correlation between serum GFAP level and NIHSS score at the fifth day or the seventh day, respectively （ P 〈 0.05 ）, and there was also significant linear positive correlation between GFAP on the fifth day and the seventh day and BI score at discharge （ P 〈 0. 05 ）. Conclusion GFAP level in blood of patients with acute cerebral infarction increase markedly, which might be a useful marker for disease assessment and prognosis predicting.