急性小脑出血患者失眠与出血部位、神经损伤程度和IL-1β浓度的关系

Correlation of insomnia with hemorrhagic site, degree of nerve injury and IL-1β concentration in patients with acute cerebellar hemorrhage

目的监测急性小脑出血患者的睡眠状态,并分析其与出血部位、神经损伤程度、血浆中IL-1β浓度的关系。方法选择2014年4月至2016年11月在武汉大学人民医院神经内科治疗的小脑出血患者127例,根据PSQI量表得分将其分为小脑出血伴失眠组72例及小脑出血非失眠组55例,并设立健康组(18例),分析组间临床一般资料、睡眠状况、多导睡眠仪相关数据及IL-1β浓度间的差异。结果小脑出血伴失眠组患者的睡眠质量评分(PSQI)为(16.34±5.32)分、Epworth评分为(10.54±4.77)分,均明显高于小脑出血无失眠组的(6.28±3.55)分、(4.67±4.21)分以及健康组的(4.79±2.79)分、(3.26±3.73)分,差异均具有统计学意义(P<0.05);小脑出血伴失眠组患者的出血量为(10.26±4.85)m L、神经损伤程度评分(NIHSS)为(10.68±1.07)分,均显著高于小脑出血无失眠组的(7.56±3.80)m L、(6.28±3.55)分及健康组的0 m L、(4.79±2.79)分,差异均有统计学意义(P<0.05)。小脑出血伴失眠组患者总睡眠时间为(345.98±49.75)min,明显短于小脑出血非失眠组的(405.15±52.83)min及健康组的(423±50.21)min,并且小脑出血伴失眠组睡眠潜伏期[(47.61±19.23)min]、S1期睡眠比例[(19.25±4.26)%]明显高于小脑出血非失眠组[(47.61±19.23)min、(12.29±3.21)%]以及健康组[(21.36±13.24)min、(9.02±3.99)%],而REM睡眠比例显著减少[(13.78±4.23)%vs(21.56±3.89)%、(22.77±3.75)%],差异均具有统计学意义(P<0.05)。此外,小脑出血伴失眠组[(14.75±4.88)ng/L]与小脑出血非失眠组[(9.65±3.11)ng/L]血浆中IL-1β浓度均显著高于健康组[(2.65±1.02)ng/L],差异有统计学意义(P<0.05)。结论急性小脑出血患者的出血量、神经损伤程度、出血部位及血浆中IL-1β浓度可以影响患者的睡眠状态。

Objective To monitor the sleep states of patients with acute cerebellar hemorrhage, and to analyze the correlation of insomnia with hemorrhagic site, degree of nerve injury and IL-1β concentration. Methods The patients with cerebellar hemorrhage who admitted to Department of Neurology of our hospital were divided into the cerebellar hemorrhage with insomnia group, the cerebellar hemorrhage without insomnia group, and the healthy group. The difference of general clinical data, sleep states, data of Methods Polysomnography（PSG） and concentration of IL-1β of each group were analyzed. Results The scores of Pittsburgh Sleep Quality Index（PSQI） and Epworth Sleepiness Scale（ESS） of the cerebellar hemorrhage with insomnia group were（16.34±5.32） and（10.54±4.77）, respectively, which were significantly higher than（6.28±3.55） and（4.67±4.21） of the cerebellar hemorrhage without insomnia group and（4.79±2.79） and（3.26 ± 3.73） of the healthy group（P〈0.05）. The amount of bleeding and National Institutes of Health Stroke Scale（NIHSS） scores of the cerebellar hemorrhage with insomnia group were（10.26±4.85） m L and（10.68±1.07）, which were significantly higher than（7.56±3.80） m L and（6.28±3.55） of the cerebellar hemorrhage without insomnia group and0 m L and（4.79 ± 2.79） of the healthy group（P〈0.05）. The total sleep time of the cerebellar hemorrhage with insomnia group was（345.98 ± 49.75） min, which was significantly lower than（405.15 ± 52.83） min of the cerebellar hemorrhage without insomnia group and（423±50.21） min of the healthy group（P〈0.05）; the sleep latency and S1 sleep ratio of the cerebellar hemorrhage with insomnia group were respectively（47.61±19.23） min（19.25±4.26）%, which were significantly higher than（21.36±13.24） min and（16.35±4.26）% of the cerebellar hemorrhage without insomnia group and（12.29±3.21） min and（9.02±3.99）% of the healthy group（P〈0.05）. The percentage of rapid eye movement（REM） sleep in the cerebellar hemorrhage with insomnia group was（13.78±4.23）%, which was significantly lower than（21.56±3.89）% of the cerebellar hemorrhage without insomnia group and（22.77±3.75）% in the healthy group（P〈0.05）. Moreover, the concentration IL-1β in the cerebellar hemorrhage with insomnia group was（14.75±4.88） ng/L, which was significantly higher than（9.65±3.11） ng/L in the cerebellar hemorrhage without insomnia group and（2.65±1.02） ng/L in the healthy group（P〈0.05）. Conclusion The amount of bleeding, the degree of nerve injury, the hemorrhagic site, and the concentration of plasma IL-1β can affect the patient＇s sleep state in patients with acute cerebellar hemorrhage.