脑出血与蛛网膜下腔出血后β-内啡肽和促性腺激素释放激素水平变化研究

Changes of β- endorphin and Gonadotropin Releasing Hormone after Cerebral Hemorrhage and Subarachnoid Hemorrhage

目的动态观察脑出血(ICH)及蛛网膜下腔出血(SAH)后β-内啡肽、促性腺激素释放激素(GnRH)水平,探讨ICH、SAH丘脑应激反应的差异。方法分别选取2014年5月—2016年5月于重庆市中医院神经外科住院的符合纳入标准的自发性ICH患者38例为ICH组,自发性SAH患者26例为SAH组。同期选取于本院行腰穿麻醉术的无神经系统疾病患者20例为对照组。分别检测并记录对照组患者入院时血浆、脑脊液中β-内啡肽、GnRH水平,ICH组、SAH组患者入院时及入院1、3、7、14、30 d血浆、脑脊液中β-内啡肽、GnRH水平。结果 ICH组根据剔除标准剔除18例,最终纳入20例;SAH组根据剔除标准剔除6例,最终纳入20例。ICH组、SAH组入院时及入院1、3、7、14、30 d血浆、脑脊液β-内啡肽水平高于对照组(P<0.05);SAH组入院时及入院1、3、7、14、30d血浆、脑脊液β-内啡肽水平高于ICH组(P<0.05)。ICH组、SAH组入院时及入院1、3、7、14、30 d血浆、脑脊液GnRH水平高于对照组(P<0.05);SAH组入院时及入院1、3、7、14、30 d血浆、脑脊液GnRH水平高于ICH组(P<0.05)。结论β-内啡肽和GnRH参与ICH、SAH下丘脑应激反应,ICH下丘脑应激反应比SAH轻,监测血液、脑脊液β-内啡肽、GnRH水平对脑损伤程度判定及预后评估有重要临床意义。

Objective To observe the levels of β - endorphin and gonadotropin releasing hormone （ GnRH） dynamically after the intracerebral hemorrhage（ICH）and subarachnoid hemorrhage（SAH）,and explore difference of thalamus stress reaction between ICH and SAH. Methods According to the inclusion criteria,38 patients with spontaneous ICH and 26 patients with spontaneous SAH in the Department of Neurosurgery of Chongqing Traditional Chinese Medicine Hospital from May 2014 to May 2016 were respectively selected into ICH group and SAH group. At the same time,20 patients without neurological disease who underwent lumbar puncture anesthesia in the same hospital were selected as control group. The levels of β - endorphin and GnRH in plasma and cerebrospinal fluid of patients at admission in control group,and the levels of β - endorphin and GnRH in plasma and cerebrospinal fluid of patients at the 1st,the 3rd,the 7th,the 14th,and the 30th day of admission in ICH group and SAH group were detected and recorded. Results According to the exclusion criteria,18 cases were excluded,and finally 20 cases were enrolled in ICH group;while 6 cases were excluded,and finally 20 cases were enrolled in SAH group. The levels of β- endorphin in plasma and cerebrospinal fluid at admission and at the 1st,the 3rd,the 7th,the 14th,and the 30th day of admission in ICH group and SAH group were higher than those in control group（ P ﹤ 0. 05）;the levels of β - endorphin in plasma and cerebrospinal fluid at admission and at the 1st,the 3rd,the 7th,the 14th,and the 30th day of admission in SAH group were higher than those in ICH group（P ﹤ 0. 05）. The levels of GnRH in plasma and cerebrospinal fluid at admission and＆amp;nbsp;at the 1st,the 3rd,the 7th,the 14th,and the 30th day of admission in ICH group and SAH group were higher than those in control group（P ﹤ 0. 05）;the levels of GnRH in plasma and cerebrospinal fluid at admission and at the 1st,the 3rd,the 7th, the 14th,and the 30th day of admission in SAH group were higher than those in ICH group（P ﹤ 0. 05）. Conclusion β -endorphin and GnRH participate in the hypothalamus stress reaction after SAH and ICH. The hypothalamus stress reaction after SAH is stronger than that after ICH. Monitoring β - endorphin and GnRH levels in blood and cerebrospinal fluid is of important clinical significance in determining the severity of brain injury and assessing its prognosis.