高压氧对急性脑出血患者血清NSE、BDNF、sICAM-1的影响及与脑水肿体积的相关性分析

The value of hyperbaric oxygen on NSE,BDNF,sICAM-1 in patients with acute cerebral hemorrhage and its corre-lation analysis between brain edema

目的观察高压氧对急性脑出血患者神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)、细胞间黏附因子-1(s ICAM-1)的影响及与脑水肿体积的关系。方法选取2014年12月—2016年12月中南大学湘雅医院神经外科诊治的急性脑出血患者126例作为研究对象,采用随机数字表法分为2组,对照组63例给予常规治疗,观察组63例给予常规治疗联用高压氧治疗。2组均于治疗前后行血清NSE、BDNF、s ICAM-1检测,并给予患者神经功能缺损评分(NHISS)、日常生活能力评分(ADL)、改良的Rankin量表评分(mRs),比较2组患者的脑水肿改善情况及治疗效果,分析急性脑水肿体积与各指标的相关性。结果观察组总有效率98.4%高于对照组88.9%(χ2=4.805,P<0.05);治疗后,2组患者NSE、s ICAM-1、NHISS评分、mRs评分、绝对脑水肿体积、相对脑水肿体积均降低(对照组t=6.582、6.778、12.067、8.483、8.752、15.857,P均<0.01;观察组t=11.217、11.864、27.634、14.818、16.467、25.013,P均<0.01);2组患者BDNF、ADL评分增加(对照组t=8.330、13.129,P均<0.01;观察组t=14.336、19.521,P均<0.01)。治疗后,观察组患者NSE、s ICAM-1、NHISS评分、mRs评分、绝对脑水肿体积、相对脑水肿体积低于对照组(t=6.268、6.636、11.293、7.091、8.067,7.002,P均<0.01);观察组患者BDNF、ADL评分高于对照组(t=6.913、6.260,P<0.01)。急性脑出血发生后,影像学改变可表现有脑水肿体积增加,其与NSE、s ICAM-1呈正相关,与BDNF呈负相关(P<0.01)。结论高压氧可降低急性脑出血患者血清NSE、s ICAM-1水平,增加血清BDNF水平,有助于改善脑水肿状况。

Objective To investigate effect of hyperbaric oxygen on NSE, BDNF, slCAM-1 in patients with acute cerebral hemorrhage and its relationship with brain edema. Methods One hundred ＂and twenty-six patients with acute cerebral hemorrhage were selected in hospital from December 2014 to December 2016, who were divided into two groups by ran- dom number table method. 63 patients received conventional therapy as control group. 63 patients combined with hyperbaric oxygen as observation group. NSE, BDNF, slCAM-1 detected before and after treatment. NHISS score, ADL score, mrs score were evaluated. Changes of cerebral edema and treatment effect were compared between two groups. Correlation between acute cerebral hemorrhage and each index were analyzed. Results The total effective rate in observation group was higher than control group （98.4% vs. 88.9,X2 =4.805,P 〈0.05） After treatment, NSE, sICAM-1, NHISS score, mRs score, ab- solute brain edema volume, relative cerebral edema volume decreased in both of the two groups （ control group, t = 6. 582, t = 6. 778 ,t = 12. 067 ,t =8. 483 ,t =8. 752,t = 15. 857 ,all P 〈0.01 ;observation group,t = 11. 217,t = 11. 864,t =27. 634,t = 14. 818 ,t = 16. 467, t = 25. 013, all P 〈0.01 ）. BDNF, ADL score increased in two groups （ control group,＇ t = 8. 330, t = 13. 129, all P 〈 0.01 ;observation group,t = 14. 336, t = 19. 521, all P 〈 0.05 ） ; NSE, sICAM-1, NHISS score, mRs score, absolute brain edema volume, relative cerebral edema volume in observation group were lower than control group （ t = 6. 268, t = 6.636,t = 11. 293,t = 7. 091,t = 8. 067,t = 7. 002, all P 〈0. 01 ） ; BDNF, ADL score,were higher than control group （ t =. 913 ,t = 6. 260,all P 〈0.05）. After acute intracerebral hemorrhage, there were imaging changes with brain edema volumeincreasing. Acute cerebral hemorrhage was positively correlated with NSE, slCAM-1, brain edema volume, which was nega- tively correlated with BDNF（ all P 〈 0.05）. Conclusion Hyperbaric oxygen can reduce the level of NSE, sICAM-1 and in- crease the level of BDNF in patients with acute cerebral hemorrhage, which is helpful to improve brain edema.