老年慢性硬膜下血肿及复发的相关因素研究

Study on related factors of occurrence and recurrence of chronic subdural hematoma in the elderly

目的分析老年慢性硬膜下血肿(CSDH)病人血清及血肿液中D-二聚体(D-D)、转化生长因子β1(TGF-β1)、神经元特异性烯醇化酶(NSE)及血管内皮生长因子(VEGF)水平,探讨其对老年CSDH发病及复发的预测价值。方法研究对象为我院2016～2017年收治的60例老年CSDH病人,所有病人均行钻孔引流术治疗,于术中采集每位病人的血肿液及末梢静脉血,检测病人血清和血肿液中D-D、TGF-β1、NSE及VEGF水平。同时选取30名健康对象为对照组,取其清晨空腹静脉血,并检测血清中D-D、TGF-β1、NSE、VEGF水平。结果60例老年CSDH病人中复发11例,复发率为18. 33%。CSDH组血肿液中D-D、TGF-β1、NSE、VEGF含量较CSDH组及对照组血清水平均显著增高(P<0. 05); CSDH组血清NSE浓度较对照组血清水平亦显著升高(P<0. 05),但CSDH组与对照组血清中D-D、TGF-β1、VEGF水平比较,差异均无统计学意义(P> 0. 05)。CSDH复发组血肿液中D-D、TGF-β1、NSE、VEGF水平较未复发组血肿液样本均显著升高(P<0. 01)。CSDH复发组血清NSE含量较未复发组血清浓度亦显著增加(P<0. 01),CSDH复发组与未复发组血清中D-D、TGF-β1、VEGF浓度比较,差异均无统计学意义(P>0. 05)。结论 D-D、TGF-β1、NSE及VEGF的异常升高与老年CSDH的发生及术后复发密切相关。

Objective To analyze the levels of D-dimer(DD),transforming growth factor-β1(TGF-β1),neuron specific enolase(NSE)and vascular endothelial growth factor(VEGF)in serum and hematoma fluids of the elderly patients with chronic subdural hematoma(CSDH),and to explore their predictive values in the pathogenesis and recurrence of CSDH in the elderly.Methods Sixty elderly patients with CSDH in our hospital from January 2016 to December 2017 were enrolled in this study.All patients received drainage treatment.The hematoma fluid and peripheral venous blood during surgery were collected,and the levels of D-D,TGF-β1,NSE and VEGF in serum and hematoma fluid were detected.Meanwhile 30 healthy cases were selected as control group,and the fasting venous blood in the morning was collected for the measurement of serum D-D,TGF-β1,NSE and VEGF.Results Among the 60 elderly cases with CSDH,11 cases presented with recurrences and the recurrence rate was 18.33%.The levels of D-D,TGF-β1,NSE,and VEGF in hematoma fluid of CSDH group were significantly higher than those in the serum of CSDH group and control group(P<0.05).The serum level of NSE in CSDH group was significantly higher than that in control group(P<0.05).There were no statistical differences in the serum levels of D-D,TGF-β1,and VEGF between CSDH group and control group(P>0.05).The levels of D-D,TGF-β1,NSE,and VEGF in hematoma fluid in recurrence group were significantly higher than those in non-recurrence group(P<0.01).The serum level of NSE in recurrence group was significantly higher than that in non-recurrence group(P<0.01),and there were no statistical differences in serum D-D,TGF-β1,and VEGF levels between recurrence group and non-recurrence group(P>0.05).Conclusions The abnormal increase of D-D,TGF-β1,NSE and VEGF is closely related to the occurrence of CSDH and postoperative recurrence in the elderly.