脑肿瘤卒中患者治疗前后血清ADMA的变化及临床意义

Changes and clinical significance of serum ADMA levels in patients with brain tumors complicated with stroke before and after treatment

目的探讨手术治疗对脑肿瘤卒中患者非对称二甲基精氨酸(ADMA)蛋白表达的影响。方法选取2015年3月至2018年1月间湖北省江陵县人民医院收治的200例脑肿瘤卒中患者,按起病至手术治疗时间分为0~3h组和3~4.5h组,每组100例。比较两组患者手术治疗前后阿尔茨海默病评估量表(ADAS-Cog)和卒中量表(NIHSS)评分,检测患者血小板(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)及纤维蛋白原(FIB)水平,采用酶联免疫双抗体夹心法(ELISA)检测溶栓前后血清中ADMA蛋白表达,观察两组患者不良反应。结果治疗前,两组患者ADAS-Cog和NIHSS评分比较,差异无统计学意义。治疗后,两组患者ADAS-Cog和NIHSS评分均降低,且0~3h组患者评分均低于3~4.5h组,差异均有统计学意义(均P<0.05)。治疗前,两组患者凝血功能指标比较,差异无统计学意义。治疗后,两组患者凝血功能各指标均不同程度升高,其中0~3h组患者PLT及MPV与治疗前比较,差异均有统计学意义(均P<0.05)。且0~3h组患者四项指标均高于3~4.5h组,但差异无统计学意义(P>0.05)。治疗前,两组患者ADMA水平比较,差异无统计学意义。治疗后,两组患者ADMA水平均下降,且0~3h组患者ADMA水平高于3~4.5h组,差异均有统计学意义(均P<0.05)。两组患者均发生皮疹、恶心呕吐和血小板过低等不良反应,但发生率比较,差异无统计学意义(P>0.05)。结论早期手术治疗能有效改善脑肿瘤卒中患者的临床症状,降低血清ADMA水平。

Objective To observe the expression of asymmetric dimethylarginine（ADMA） in patients with brain tumors complicated with stroke before and after surgical treatment.Methods Two hundred patients with brain tumors complicated with stroke treated at Jiangling County People＇s Hospital from March2015 to January 2018 were selected as the subjects.According to the time from the disease onset to surgery,the patients were divided into 0~3 h group and 3~4.5 h group,with 100 hundred patients in each group.Before and after surgical treatment,the Alzheimer＇s disease assessment scale（ADAS-Cog score） and NIHSS score of the two groups were compared.Platelet count（PLT）,mean platelet volume（MPV）,platelet distribution width（PDW） and fibrinogen（FIB） level were detected.The expression of ADMA in serum before and after thrombolysis was detected by enzyme-linked immunosorbent assay（ELISA）.The adverse reactions were observed.Results Before the treatment,there was no significant difference in the scores of ADAS-Cog and NIHSS between the two groups（P〈0.05）.After the treatment,the scores of ADAS-Cog and NIHSS decreased in both groups and the scores were lower in the 0-3 h group than in the 3-4.5 h group（all P〈0.05）.There was no significant difference in coagulation function indexes between the two groups（P〈0.05）.After the treatment,coagulation function indexes increased to some degree in both groups and for the 0~3 h group,there was significant differences in PLT and MPV compared with before the treatment（all P〈0.05）.The above four indexes were higher in the 0~3 h group than in the 3-4.5 h group but the differences were not significant（P〉0.05）.Before the treatment,there was no significant differences in ADMA between the two groups（P〉0.05）.After the treatment,ADMA decreased in both groups with the levels higher in the 0-3 h group than in the 3-4.5 h group（all P〈0.05）.Adverse reactions such as rash,nausea and vomiting thrombocytopenia occurred in both groups but the difference in the incidence of adverse reactions between the two groups was not significant（P〉0.05）.Conclusion Early surgical therapy can effectively improve the clinical symptoms and decrease serum ADMA levels.