脑出血患者颅内血肿中血红素加氧酶1和非结合胆红素的含量变化及其与迟发性脑水肿的关系研究

Contents and clinical significance of heme oxygenase-1 and unconjugated bilirubin in intracranial hematoma of cerebral hemorrhage patients

目的研究脑出血患者颅内血肿中的血红素加氧酶1(HO-1)和非结合胆红素(UCB)的含量变化,探讨脑出血后迟发性脑水肿的病理机制。方法选择脑出血行颅内血肿微创清除术患者30例(脑出血组),同时选择健康体检者20例(对照组);用酶联免疫吸附测定(ELISA)法和钒酸盐氧化法检测对照组和脑出血组第1天、第3天和第6天颅内血肿中的HO-1和UCB含量,并应用多田公式计算术后第6天血肿周围脑水肿的体积。结果脑出血组第1天颅内血肿中HO-1的含量(13.96±4.83)μg/L和UCB的含量(11.34±2.96)μmol/L均较对照组(3.53±2.07)μg/L、(7.13±2.74)μmol/L明显增高(P<0.01);并且脑出血组第3天HO-1、UCB(25.60±7.13)μg/L、(28.45±7.69)μmol/L均达到高峰,第6天(18.77±5.39)μg/L,(20.18±4.75)μmol/L有所下降,与第1天比较差异均有统计学意义(P<0.01)。并且第6天HO-1和UCB的含量与脑水肿的体积均呈正相关(r值分别为0.453、0.525,均P<0.05)。结论HO-1和UCB可能在脑出血后迟发性脑水肿的形成中起着重要作用。

Objective To investigate the content of heme oxygenase-1 （HO-1） and unconjugated bilirubin（UCB） in the intracranial hematoma. Methods Thirty patients of cerebral hemorrhage who had minimally invasive operation were enrolled,and the contents of HO-1 and UCB were detected in the first day, third day and sixth day after the operation by ELISA and oxidation of vanadate. Twenty healthy adults served as control group. And the volume of cerebral edema was measured in the sixth day. Results The contents of HO-1 and UCB in the first day increased much higher than those of control group, （13.96±4.83）μg/L and （11.34±2.96）μmol/L vs （3.53±2.07）μg/L and （7.13± 2.74） μmol/L（ P 〈0.01）. The contents of HO-1 and UCB in the third day reached the peak,（25.60±7.13） μg/L and （28.45±7.69） μmol/L. The contents of HO-1 and UCB in the sixth day （18. 77±5.39） μg/L,（20.18±4. 75） μmol/L decreased, but were still higher than those of the first day （ P〈0.01 ）. And the contents of HO-1 and UCB in the sixth day were correlated with the volume of cerebral edema（ r= 0. 453,0. 525 respectively, P 〈0.05）. Conclusion HO-1 and UCB may play important roles in the mechanism of the tardive cerebral edema after hemorrhage.