缺血性脑卒中患者血清肌肽酶的动态变化及其意义

Clinical Investigation of Serum carnosinase in Patients with Acute Cerebral Ischemia

目的观察急性缺血性脑卒中患者血清肌肽酶(HSC)的变化,并探讨HSC水平同脑梗死灶大小、神经学状态和功能间的关系。方法采用荧光法分光光度法检测急性脑缺血患者发病后48h内、第5d、第7d和第14dHSC活性。所有患者于相应时间点进行神经学状态评估(NIHSS),出院时评估神经学功能(Barthel index)。结果 (1)HSC于发病第5d即开始降低,第7d显著低于对照组(P=0.034),第14d升高到正常水平(P=0.105);虽然发病48h内、5d及14dHSC同对照组无显著差异,但第5d、第7d和第14dHSC活性均显著低于第3d(P=0.023,0.002和0.013),第7d也低于第5d(P=0.000),第14d同第5d和第7d相比无差异(P>0.05)。(2)发病后的第7d和第14d,大梗死灶组、小梗死灶组和对照组HSC差别显著(P=0.032和0.033)。经两两比较,大梗死灶组于第7天HSC显著低于对照组(P<0.05),第14dHSC也分别低于较小梗死灶组和对照组(均为P<0.05),而小梗死灶组和对照组均无差异(P>0.05)。(3)未发现HSC同NIHSS和Barthel Index有显著意义的相关性。结论急性缺血性脑卒中患者发病后HSC活性显著降低,并且梗死灶大的患者降低的幅度大。HSC能否作为缺血性脑损伤严重程度的判断指标值得进一步关注。

Objective Serum carnosinase and their temple profile were determined in patients with acute cerebral ischemia,and relationship between its level and size of brain lesions,neurological status（NIHSS） and functional outcome （Barthel Index） were also investigated. Methods Fluorescent （spectrophotometric method were used to determine serum carnosinase activity in patients with acute cerebral ischemia at 48th hour, 5th day, 7th and 14th day after onset of stroke. All patients＇ neurological status was evaluated by National Institutes of Health Stroke Scale （NIHSS） at corresponding time,and functional outcome was evaluated by Barthel Index at discharge from hospital. Results （1） For all patients observed,serum carnosinase began to decrease at 5th day,and was lower than that of control group at 7th day （P〈0. 034）. HSC level increased to normal level at 14th day（P=0. 105） . Although there was no statistical decrease at 3th day, 5th day and 14th day compared with control group, we found significantly decreased carnosinase activity of patients group at 5th,Tth,and 14th day compared with that at the 3th day by paired t test （P=0. 023,0. 002和l 0. 013）, greatly decreased carnosinase activity at 7th day compared with 5th day （P= 0. 000）, and increased enzyme activity at 14th day so as to there was no significant difference compared with 5th and 7th day（P〉0.05）. （2）For serum carnosinase activity at 7th day and 14th day,there was significant difference among patients with larger, smaller size of brain lesion and normal control group. Patients with larger size of brain lesion have relatively lower serum carnosinase activity. （3）No Significant correlation between serum carnosinase activity and NIHSS score and Barthel index score at any time point abserved. Conclusion Serum carn0sinase activity decreased markedly after onset of acute cerebral ischemia,and patients with larger size of brain lesion had much lower HSC activity. Whether HSC could be a marker for the assessment of cerebral ischemia severity deserves further attention.