C-反应蛋白水平与脑出血预后相关性的研究

Study on the correlation of C -reactive protein level and cerebral hemorrhage prognosis

目的分析急性脑出血C-反应蛋白（CRP）水平的动态变化及其与脑出血预后相关性，为病情及预后判断提供依据。方法选择烟台经济技术开发区医院神经内科收治的急性自发性脑出血住院患者为研究对象，共计纳入163例患者符合病例入选标准，所有患者均于发病第1天、3天、7天、14天后采用免疫比浊法检测血清中CRP，进行神经功能缺损NIHSS评分，同期入组48例健康体检者作为对照组，比较脑出血组与健康对照组不同脑出血量患者、不同神经功能缺损程度患者血清CRP水平差异。结果（1）脑出血组人院当天CRP为（8．92±1．0）mg／L，对照组为（4．25±0．23）mg／L，脑出血组CRP水平明显高于对照组，差异有统计学意义，t=一3．683，P〈0．01。（2）脑出血患者入院后1、3、7、14d平均血清CRP分别为（9．34±1．65）mg／L、（9．56±1．58）mg／L、（6．58±1．17）mg／L、（4．98±1．26）mg／L，第1天CRP水平开始升高，第3天达到峰值（F=7．487，P〈0．05），大量、中量、小量脑出血量患者CRP水平于人院后第1天、第3天、第7天CRP水平存在明显差异，大量脑出血患者CRP水平均明显高于中等及小量脑出血患者（F=3．31、4．62、4．21，P〈0．01或P〈0．05）。（3）轻度、中度、重度神经缺损程度的急性脑出血患者CRP水平均于第3天达到峰值，第7、14天逐渐降低，第3天CRP水平明显高于第1天，第7、14天水平明显低于第1天，轻度、中度、重度神经缺损程度的急性脑出血患者第1天、3天、7天、14天组间CRP动态水平差异有统计学意义（F=4．29、5．32、3．62、3．21，P〈0．05或P〈0．01），重度神经缺损程度的急性脑出血患者第1天、3天、7天、14天的CRP水平明显高于轻度和中度患者（t=6．567、4．241、4．010、3．511和4．965、3．031、3．104、3．009，P〈0．05或P〈0．01）。结论急性脑出血患者血清CRP存在动态变化，在发病第3天达到峰值，CRP水平与脑出血预后明显相关，神经功能缺损越严重，脑出血量越大，血清CRP水平越高。

Objective To analyze the correlation of C - reactive protein level and acute cerebral hemorrhage prognosis, provide the evidence for determining the condition and prognosis. Methods 163 patients with acute spon- taneous intracerebral hemorrhage met selection criteria in Yantai Economic and Technology Development Area Hospi- tal were selected as the study objects, the CRP were detected by immunoturbidimetry in the 1 day, 3 days,7 days, 14 days after admission, the NIHSS were calculated ,48 cases of healthy people were selected as the control group, the CRP between hemorrhage group and the healthy control group, patients with different brain hemorrhage, patients with different neurological deficit were compared. Results （ 1 ） The C - reactive protein of cerebral hemorrhage group when admission were （ 8.92 ±1.0 ） mg/L, the control group were （4.25±0.23 ） mg/L, the C - reactive protein of cer- ebral hemorrhage group were significantly higher than that of the control group, the difference was statistically signifi- cant, t = - 3. 683,P 〈 0.01. （2） The mean serum CRP after admission admission 1,3,7,14d were （ 9.34 ± 1.65 ） mg/L, （9.56 ± 1.58 ） mg/L, （6.58± 1.17 ） mg/L, （4.98 ±1.26 ） mg/L, the CRP was a large rise in the course of the disease 1 d,3 d peak, F = 7. 487, P 〈 0.05, the CRP had difference between large amount of brain hemorrhage, moder- ate amount of brain hemorrhage, and small amount of brain hemorrhage, a large amount of patients with cerebral hem- orrhage CRP levels were higher than a moderate amount of patients with cerebral hemorrhage and a small amount of patients with cerebral hemorrhage 1,3 and 7d, during which the difference was statistically significant（ F = 3.31, 4. 62,4.21 ,P 〈0.01 or P 〈0.05 ）. （3）The CRP peak levels of different degrees of neurological deficits in patients with acute cerebral hemorrhage decreased in 3d ,7d, 14d, the CRP of 3 d were higher than that in 1 d,the CRP of 7,14d were lower than that in 1 d, CRP levels between different neurological deficits degree of acute cerebral hemorrhage were also significantly different （ F = 4.29,5.32,3.62,3.21,P 〈 0.05 or P 〈 0.01 ） , the CRP levels of Severe neurological deficit in l d, 3d, 7d, 14d were significantly higher in mild and moderate neurological deficit （t = 6. 567,4. 241, 4.010,3.511 and 4. 965,3. 031,3. 104,3. 009,P 〈0.05 or P 〈0.01）. Conclusion The serum CRP levels of patients with acute cerebral hemorrhage significantly increased, the serum CRP level shows dynamic changes in the first three days of the onset of peak, the CRP levels significantly correlated with the prognosis of cerebral hemorrhage, the more severe neurological deficit, the greater the amount of cerebral hemorrhage, higher serum CRP levels.