缺血性脑卒中患者血清胶质纤维酸性蛋白和S-100ββ蛋白的变化

Changes in Serum Glial fibrillary Acidic Protein and S-100β β in Patients with Cerebral Ischemia

目的:探讨急性缺血性脑卒中患者血清胶质纤维酸性蛋白(GFAP)和S-100ββ蛋白与梗死病灶、神经学状态和神经学预后间的关系。方法:37例急性脑缺血患者(卒中组)发病<48 h,5、7和14 d时检测血清GFAP和S-100ββ蛋白水平,并于相应时间进行神经学状态(NIHSS)和出院时神经学功能(BI)评估。结果:①血清GFAP水平,卒中组发病<48 h即明显高于与其匹配的健康人(对照组)(P<0.05),7 d时与对照组接近,14 d又明显升高(P<0.05);S-100ββ水平,卒中组7 d时达高峰,14 d下降,但与对照组比较均差异无显著性意义。②梗死灶较大和中等患者,GFAP水平在发病<48 h明显高于较小梗死灶和对照组(P<0.05,0.01);S-100ββ水平较大梗死灶患者在<48 h时显著高于中等、较小梗死灶及对照组,7 d时中等梗死灶则明显高于较大梗死灶(均P<0.01)。③发病5及7 d时GFAP水平与相应的NIHSS呈负相关,与出院时BI呈正相关(均P<0.05);S-100ββ水平与各时间点NIHSS和出院时BI均有相关性(P<0.01)。发病7 d时血清GFAP与S-100ββ水平呈负相关(P<0.05)。结论:作为胶质细胞增多症和星形胶质细胞激活的标志物,GFAP和S-100ββ在脑卒中血液中表达明显增强,有望成为缺血性脑卒中早期评估、揭示疾病严重程度和评估预后的指标。

Objective： To observe the changes of GFAP and S-100ββ protein in serum of patients with acute cerebral ischemia and their relationship with cerebral infarction, neurological status and prognosis. Methods： The GFAP and S-100ββ protein in serum of patients with acute cerebral ischemia（stroke group） at the time less than 48th hours, 5th, 7th and 14th day after onset of stroke. All patients＇ neurological status was evaluated by NIHSS at corresponding time points, and the prognosis was evaluated by BI at discharge from hospital. Results： （1）The GFAP level of stroke group increased remarkably compared with control group at the time less than 48th hours （P〈0.05）, and it was close to the control group at 7th day. But it increased again and increased obviously at 14th day （P〈0.05）. The S-100ββ level peaked at 7th day, and decreased at 14th day, but there was no significant difference with the control group. （2）At the time less than 48th hours, the GFAP level of patients with larger, middle size of cerebral infarction remarkably more than smaller infarction （P〈0.05） and the control group （P〈0.01）. And at the time less than 48th hours, the S-100ββ level of patients with larger infarction obviously higher than middle and smaller infarction and the control group （P〈0.01）. At 7th day, the S-100ββ level of patients with middle infarction obviously higher than the larger infarction （P〈0.01）. （3）At 5th day and 7th day, the GFAP level was negative correlation with NIHSS score and was positive correlation with BI score （P〈0.05）. And the S-100ββ level was correlation with NIHSS and BI score （P〈0.01）. There was significant negative correlation between GFAP and S-100ββ level at 7th day （P〈0.05）. Conclusion： As marker of gliocytosis and activation of astrocyte, the expression of GFAP and S-100ββ in serum of patients with cerebral ischemia was increased obviously, which might be useful for early assessment, revealing severity and predicting prognosis of cerebral ischemia.