颅脑外伤患者UCH-L1和NSE含量及手术前后变化的临床意义

Clinical Significance of UCH-L1 and NSE in Patients with Craniocerebral Trauma and the Dynamic Variety before and after Operation

目的:探讨颅脑损伤患者血清泛素羧基末端水解酶L1(UCH-L1)和神经元特异性烯醇化酶(NSE)的含量及手术前后变化与预后的关系。方法:选择颅脑损伤患者180例,按格拉斯哥昏迷评分(GCS)分为轻度组(13～15分,60例),中度组(9～12分,60例)和重度组(3～8分,60例),入院时手术指征明确者急诊手术治疗,采集所有患者伤后12 h、24 h、3 d、7 d、14 d、28 d静脉血,采用固相夹心酶联免疫吸附法测定血清UCH-L1水平,采用酶联免疫吸附法检测血清NSE水平,随访6个月分析UCH-L1及NSE水平动态变化与损伤程度及预后的关系,应用Spearsman等级相关性分析血清UCH-L1及NSE水平与GOS评分预后不良的相关性。结果:三组比较,中度组血清UCH-L1及NSE水平明显高于轻度组(P<0.05),重度组明显高于中度组(P<0.05),手术后预后不良组血清UCH-L1及NSE水平明显高于预后良好组(P<0.05),三组血清UCH-L1与NSE水平动态变化分析,轻度组伤后24 h达到峰值,中度组伤后3 d达到峰值,重度组伤后7 d达到峰值,手术后预后良好组伤后3 d达到峰值,手术后预后不良组伤后7 d达到峰值,差异均有统计学意义(P<O.05),血清UCH-L1与NSE水平与颅脑外伤患者的预后呈负相关(P<0.05)。结论:颅脑损伤患者的UCH-L1及NSF含量可在一定程度上反映脑组织的损伤程度,伤后7 d血清UCH-L1和NSE的动态变化有助于判断患者预后,持续升高超过3 d者提示预后不良。

Objective:To investigate the relation of Ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) and neuronspecific enolase(NSE)in patients of craniocerebral injury and dynamic variety before and after operation with the prognosis of patients.Method:180 patients with traumatic brain injury (TBI) were selected as research objects.According to Glasgow Coma Scale(GCS),the patients were divided into three groups:mild group (GCS 13-15 scores,60 cases),moderate group (GCS 9-12 scores,60 cases) and severe group (GCS 3-8 scores,60 cases).The serum levels of UCH-L1 and NSE were detected in TBI patients at 12 h,24 h,3 d,7 d,14 d and 28 d after injury.The correlation between the dynamic changes of UCH-L1 and NSE and the degree of injury and prognosis were analyzed.The correlation between serum UCH-L1 and NSE levels and poor prognosis of GOS score by Spearsman grade correlation analysis.Result:In the three groups,serum UCH-L1 and NSE levels were significantly higher in moderate group than those of mild group(P<0.05).The severe group was significantly higher than that of moderate group(P<0.05).The levels of serum UCH-L1 and NSE in the patients with adverse prognosis were significantly higher than those in the good prognosis group.By analysing the dynamic changes of serum UCH-L1 and NSE levels in three groups,the mild group reached the peak at 24 h,the moderate group reached the peak at 3d,and the severe group reached the peak at 7d.After the operation,the good prognosis group of TBI reached peak at 3 d,and the poor prognosis group at 7d.The differences were statistically significant(P<0.05).The levels of serum UCH-L1 and NSE were negatively correlated with the prognosis of craniocerebral trauma patients(P<0.05).Conclusion:The content of UCH-L1 and NSE in patients with TBI can reflect the degree of brain tissue injury.And the dynamic changes of serum UCH-L1 and NSE in 7 days after injury can help to judge the prognosis of patients.It is suggested that the prognosis will be poor after a continuous elevation of serum UCH-L1 and NSE for more than 3 days.