脑出血急性期肌酶谱变化的临床意义分析

Clinical Significance of the Changes of Serum Muscle Enzyme Spectrum in Patients with Cerebral Hemorrhage

目的:研究脑出血急性期肌酶谱变化的临床意义。方法:急性脑出血患者186例为脑出血组,同期功能性头痛患者86例为对照组;测定2组患者血清肌酶水平(CK、CK-MB、LDH、AST)并进行比较;分析不同出血部位、出血量、意识状态、预后及血肿破入脑室情况的脑出血患者急性期肌酶谱变化的差异。结果:脑出血组CK、LDH、AST较对照组明显升高(P<0.05)。不同出血部位的脑出血者肌酶谱差异无统计学意义;破入脑室者仅LDH高于未破入脑室者(P<0.05);严重意识障碍者肌酶谱均高于意识障碍轻者(P<0.05);大量出血者CK及LDH明显高于小量出血者(P<0.05);死亡者仅LDH高于存活者(P<0.05)。结论:脑出血急性期血清肌酶的升高程度(特别是CK和LDH)对脑出血病情严重程度的评估有提示作用,对患者近期预后的判定仅LDH价值较大。

Objective：To analyze the changes of the serum muscle enzyme spectrum and its clinical sig- nificance in patients with cerebral hemorrhage. Methods： One hundred and eighty six patients with acute cerebral hemorrhage （cerebral hemorrhage group） and eighty six patients with fimctional headache （control group） were enrolled. The serum muscle enzyme （CK, CK-MB, LDH, AST） levels of patients in the two groups were measured and compared. The differences of muscle enzyme spectrum changes among cerebral hemorrhage patients with different position of bleeding, amount of bleeding, conscious state, prognosis and state of blood whether or not broken into the ventricle were compared and analyzed. Resuits： The serum CK, LDH and AST levels of patients in the cerebral hemorrhage group were obviously higher than those in the control group （P〈0.05）. There was no significant difference in muscle enzyme spectrum level of cerebral hemorrhage patients with different position of bleeding. Only LDH level of cerebral hemorrhage patients with blood broken into the ventricle was significantly higher than that of patients without blood broken into the ventricle （P〈0.05）. The serum muscle enzyme of patients with severe disturbance of consciousness was higher than that of patients with mild disturbance of consc iousne ss （P〈0.05）. The CK and LDH level of patients with large amount of bleeding were significantly higher than those of patients with small amount of bleeding （P〈0.05）. Only LDH level of the death was significantly higher than that of the survivors （P〈0.05）. Conclusion： The elevation of serum muscle enzymes（especially CK and LDH）in acute phase of cerebral hemorrhage is helpful in assessing the severity of the disease, while LDH is valuable for the judgment of the recent prognosis of the disease.