脑出血中风闭、脱证患者血浆及血肿引流液凝血酶-抗凝血酶复合物表达临床观察

Analysis of Thrombin-antithrombin Complex Expressions in the Plasma and the Hematoma Fluid of Intracerebral Hemorrhage Patients of Excess Syndrome of Stroke and Depletion Syndrome of Stroke

目的动态观察脑出血(ICH)中风闭、脱证患者血浆及血肿液凝血酶-抗凝血酶(thrombin-an-tithrombin,TAT)复合物的表达情况,探讨出血中风闭、脱证与TAT复合物表达的关系。方法 60例ICH患者根据中医辨证分为阳闭证(18例)、阴闭证(22例)、脱证(20例)3组,并进行出血量评估及格拉斯哥昏迷量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分;另选福建中医药大学附属第二人民医院体检中心健康体检者30名作为正常对照组;另选外科、妇科盆腔及下肢疾病且不伴有心脑血管疾病需腰椎麻醉进行手术的患者10例作为脑脊液对照组;采用ELISA法对ICH组静脉血及血浆血肿引流液、对照组静脉血浆或脑脊液检测TAT复合物。结果各型按出血量和NIHSS评分高低顺序排列为脱证>阴闭>阳闭,按GCS评分高低排列为阳闭>阴闭>脱证。与组内1、2天比较,ICH组第4天血浆TAT复合物含量降低,差异有统计学意义(P<0.01)。与正常对照组比较,ICH组第1、2、4天血浆TAT复合物均升高,差异有统计学意义(P<0.01)。ICH组第1、2、4天血肿引流液TAT复合物含量两两比较,差异有统计学意义(P<0.01),与脑脊液对照组比较,ICH组血肿引流液TAT复合物含量升高,差异有统计学意义(P<0.01)。出血量与GCS评分呈负相关(r=-0.833,P<0.01),与NIHSS评分呈正相关(r=0.809,P<0.01);ICH组TAT复合物明显高于两个对照组(P<0.01),且存在动态演变;阳闭、阴闭、脱证TAT复合物存在明显差异(P<0.01);ICH组血浆和血肿引流液TAT复合物含量变化与GCS评分呈负相关(P<0.01),与NIHSS评分呈正相关(P<0.01)。结论 TAT复合物参与了ICH后继发性神经元损伤,可作为临床病情观察客观化指标,并提供闭、脱证定量化依据。

Objective To study the relationship between the expressions of thrombin-antithrombin（TAT） complex and excess syndrome of stroke（ESS） and depletion syndrome of stroke（DSS） by dynamically observing the expressions of TAT complex in the plasma and hematoma fluid of intracerebral hemorrhage（ICH） patients.Methods Sixty patients were assigned to three groups according to syndrome typing,i.e.,as yang excess group（18 cases） ,yin excess group（22 cases） ,and depletion syndrome group（20 cases） .The hemorrhage volume was assessed.NIHSS and GCS were scored.Besides,30 healthy volunteers at the Physical Examination Center,Second People＇s Hospital Affiliated to Fujian University of Traditional Chinese Medicine were recruited as the normal control group.Another 10 patients in need of lumbal anesthesia were recruited as the cerebrospinal fluid control group,who suffered from surgical,gynecologic pelvic diseases,or diseases from lower limbs,but unaccompanied with cardio-/cerebrovascular diseases.The expressions of TAT complex were detected in the venous blood and hematoma fluid of the patient groups and in the venous blood or the cerebrospinal fluid of the control group using ELISA.Results The syndromes were sequenced as the depletion syndromethe yin excess syndromethe yang excess syndrome according to the hemorrhage volume and NIHSS score.They were sequenced as the yang excess syndrome the yin excess syndromethe depletion syndrome according to the GCS score.The plasma TAT complex content on the 4th day in the ICH group was lower than that at the rest time points,showing statistical significance（P0.01） .Compared with the normal control group,the plasma TAT complex on the 1st,2nd,and 4th day all increased with statistical difference（P0.01） .Statistical significance of the TAT complex in the hematoma fluid of the ICH group existed when compared it on the 1st,2nd,and 4th day（P0.01） .Compared with the cerebrospinal fluid control group,the contents of the TAT complex in the hematoma fluid of the ICH group increased with statistical difference（P0.01） .The hemorrhage volume of ICH patients was positively correlated with NIHSS（r=0.809,P0.01） and negatively correlated with GCS（r=-0.833,P0.01） .The TAT complex was obviously higher in the ICH group than in the two control groups in a dynamic way（P0.01） .There was obvious difference in the expressions of TAT among yang excess group,yin excess group,and depletion syndrome group（P0.01） .The expressions of TAT in the plasma and the hematoma fluid of the ICH group were negatively correlated with GCS score and positively correlated with NIHSS score（both P0.01） .Conclusions TAT complex participated in secondary neuron injury after ICH,which could be taken as an objective index for clinical observation.It also could provide evidence for syndrome quantification of excess syndrome and depletion syndrome.