自发性脑出血脑水肿与血清铁蛋白、纤维蛋白原关系的分析

A Study on the Relationship Between Cerebral Hemorrhage Delayed Edema and Serum Ferritin,Fibrinogen

目的探讨急性脑出血(ute cerebral hemorrhage,ACH)后血清铁蛋白(SF)、纤维蛋白原(Fib)的含量变化与迟发性脑水肿的相关性及对脑出血预后的影响。方法回顾性分析接受内科保守治疗的自发性急性脑出血48例,其中并发迟发性脑水肿、未发生迟发性脑水肿各24例,分别在入院后48 h内、7 d、14 d时检测血清铁蛋白、纤维蛋白原的含量,并在同期复查颅脑CT,测量并计算得出相对水肿体积,分析迟发性脑水肿与各指标的相关性。结果在脑出血48h内,血清铁蛋白、纤维蛋白原含量较正常对照组增高不明显;于7 d、14 d时迟发性脑水肿组显著高于无迟发性脑出血组P<0.05);48 h内,血清铁蛋白、纤维蛋白原水平和相对水肿大小之间无明显相关性(r=0.020,P>0.05),而在ACH后14 d,两者之间呈显著正相关(r=0.645,P<0.01);14 d时,NIHSS评分及相对水肿体积大小在ACH并迟发性脑水肿组明显高于ACH无迟发脑水肿组(P<0.01)。结论血清铁蛋白、纤维蛋白原在脑出血后迟发性脑水肿的形成中起着重要的作用。

Objective To investigate the relationship between the changes of the Fibrinogen, Serum ferritin and de- layed cerebral edema following acute cerebral hemorrhage（A CH）. Methods Analyzed retrospectively the 48 cases of acute and conservative treated cerebral hemorrhage in 2012.12-2013.5,which 24 cases complicated with delayed cerebral edema and 24 cases not complicated. Respectively at 4Bh after admission, 7d, 14d to detect the contents of serum ferritin, fibrinogen, and observed hematoma and the surrounding low-density changes by head CT during the same period, analy- sis the relationship between the volume of delayed cerebral edema and each index. Results Cerebral hemorrhage in 48h, Serum ferritin, Fibrinogen increased than those in control group was not obvious. The levels of Serum ferritin, Fibrinogen at 7d, 14d after onset in A CH with delayed cerebral edema group were significantly higher than that of the A CH without delayed cerebra edema and control groups（P〈O.O5）. Within 48 hours, there was no correlation between Serum ferritin, Fi- brinogen level and relative edema size （r=O.020, P〉O.O5）,but after 14d, a significant positive correlation between the two （r=0.645, P〈O.OI ） ; 14d, the NIHSS score and relative volume of edema in A CH and delayed brain edemagroup was sig- nificantly higher than that of ACH without delayed cerebraledema （P〈O.O1）. Conclusion Serum ferritin, Fibrinogen may play important roles in the mechanisms of the delayed cerebral edema of ter cerebral hemorrhage.