脑脊液铁蛋白及D-二聚体在自发性蛛网膜下腔出血中的含量变化及临床意义

THE VARIETY AND CLINICAL VALUE OF FERRITIN D-DIMER IN THE CEREBROSPINAL FLUID OF PATIENTS WITH SUBARACHNOID HEMORRHAGE

目的 :动态检测脑脊液Ferritin与D dimer含量 ,探讨在SAH诊断及病情观察中的作用。方法 :脑脊液Ferritin与D dimer含量测定分别应用放射免疫分析法及单抗ELLSA双抗体夹心法。观察SAH组和对照组以及SAH不同病情及发病时间Ferritin和D dimer含量。结果 :53例SAH脑脊液Ferritin与D dimer含量在 1月内均显著增高 ,分别在 3d内及 8～ 15d时含量最高 ,且其水平与SAH病情程度一致。与同时期的CT、MRI结果比较 ,脑脊液Ferritin与D dimer含量对SAH病后 1月内诊断阳性率为 10 0 % ;而急性期CT阳性率为 85 2 % ,半月后失去诊断价值 ;MRI在急性期无作用 ,亚急性期后阳性率 88 9%。在SAH出血量少或距SAH发病时间长 ,CT扫描阴性时 ,尤其是在病后 8～ 15d时 ,脑脊液Ferritin与D dimer含量显著增高。结论 :脑脊液Ferritin与D dimer含量测定在SAH诊断与鉴别诊断中是一项敏感、可靠的指标 ,对SAH病情观察及预后评估有一定参考价值。

Objective:To investigate the value of continuous changes of ferritin and D dimer in cerebrospinal fluid(CSF)in diagnosis of subarachnoid hemorrage(SAH).Methods:Radioimmunoassay and latex agglutination immunoassay using monoclonal antibody were applied respectively to detect the levels of ferritin and D dimerin in SAH group and control group in different periods.Results:CSF of 53 patients with SAH were analysed and the concentrations of ferritin and D dimer increased significantly in the first month,proportional to the degree of SAH.The diagnostic positive rate was 100% in the first month,while the positive rates of CT and MRI were 85.2% and 88.9% respectively.The concentrations of ferritin and D dimer increased conspicuously in case of small hemorrage or long sick duration,while CT scanning was negative. Conclusion:Ferritin and D dimer would be sensitive and reliable indicators in diagnosis and differential diagnosis of SAH,and helpful to estimate the prognosis.