脑出血患者血清神经元特异性烯醇化酶的动态观察

Clinical values and temporal changes of serum neuron-specific enolase concentrations in spontaneous supratentorial intracerebral hemorrhage

目的 :探讨血清神经元特异性烯醇化酶 ( NSE)对自发性幕上出血患者出血量和预后的评估价值。 方法 :采用 EL ISA法检测 5 4例自发性幕上出血患者发病第 1、2、3、4、7、14天的血清 NSE水平。计算脑实质内血肿体积 ,评定脑室出血积分以及发病第 30天时的 Glasgow预后 ( GOS)。 结果 :血清 NSE峰值与血肿体积呈正相关 ( r=0 .5 6 ,P<0 .0 1) ,与 GOS呈显著负相关 ( r=- 0 .5 9,P<0 .0 1) ,与脑室出血积分无相关性 ( r=0 .0 6 ,P=0 .6 7)。不同血肿体积组 NSE在发病第 3天差异显著 ( P<0 .0 1)。 NSE动态曲线在发病 2 4～ 48h时骤升预示死亡。病程中NSE>2 5μg/ L的患者全部死亡。 结论 :血清

Objectives:To evaluate the clinical values of serial measurements of serum neuronspecific enolase(NSE) concentrations in patients with spontaneous supratentorial intracerebral hemorrhage. Methods:Serum NSE concentrations were examined on days 1,2,3,4,7 and 14 after ictus in 54 patients with spontaneous supratentorial intracerebral hemorrhage by enzyme linked immunosorbent assays(ELISA). Volume of parenchymal hematoma and secondary intraventricular hemorrhage was also determined. Clinical outcome was assessed on day 30 after ictus with the Glasgow Outcome Scale(GOS). Results:Serum NSE concentrations on days 1,2,3,4,7,14 after intracerebral hemorrhage were found significantly higher than those of controls (P< 0.05 ). Peak levels of serum NSE were correlated significantly with the volume of parenchymal hemorrhage(r=0.56,P<0.01) and clinical outcome(r=-0.59,P<0.01), but not with intraventricular hemorrhage volume (r=0.06, P=0.67). A higher mean serum NSE value was found in the group with a greater hematoma 3 days after the onset of hemorrhage(P<0.01). None of patients with NSE concentration above 25 μg/L survived. A sudden increased serum NSE level indicated an unfavorable outcome. Conclusions:Serum NSE concentrations in patients with intracerebral hemorrhage correlate with the volume of hematoma and severity of the disease, and can predict the shortterm neurological outcome reliably.