蛛网膜下腔出血患者脑脊液神经元特异性烯醇化酶水平变化及临床意义

Changes and clinical significance of neuron-specific enolase levels in cerebrospinal fluid in patients with subarachnoid hemorrhage

目的探讨蛛网膜下腔出血(SAH)患者发病后脑脊液中神经元特异性烯醇化酶(NES)的表达水平变化规律及其临床意义。方法选取自2018年1月至2020年6月于广州市花都区人民医院神经外科住院的64例SAH患者为研究组,选择同期因非神经系统病在我院行腰麻的手术患者64例为对照组。研究组患者发病后第1、3、5、7、10、14天行腰椎穿刺留取脑脊液标本,而对照组患者在行腰麻时留取脑脊液标本,检测NSE表达水平,对比其表达水平的变化规律。研究组患者根据病因、NIHSS评分及GOS评分进行分组,分别比较各亚组患者的脑脊液中NSE表达水平。结果研究组患者脑脊液中NES表达水平在发病后第1天开始升高,于第3~5天达到高峰,此后逐渐下降,第14天基本恢复至正常值水平。研究组中不同病因亚组患者脑脊液NSE的表达水平比较差异无统计学意义(P>0.05);不同NIHSS、GOS评分亚组患者脑脊液NSE表达水平比较差异有统计学意义(P<0.05)。结论SAH患者发病后脑脊液中NSE的表达水平在发病后即出现升高,第3~5天达高峰,其与神经损害程度及预后相关,可作为患者神经功能损害及预后评估的指标。

Objective To explore the changes in the expression level of neuron-specific enolase(NES)in the cerebrospinal fluid of patients with subarachnoid hemorrhage(SAH)and its clinical significance.Methods Sixty-four SAH patients who were hospitalized in Neurosurgery Department of People’s Hospital of Huadu District from January 2018 to June 2020 were selected as the study group.Sixty-four patients who had undergone lumbar anesthesia in our hospital for non-neurological diseases were selected as the control group.The cerebrospinal fluid samples were taken by lumbar puncture on the 1st,3^(rd),5^(th),7^(th),10^(th) and 14^(th) days after the onset of the study group,while the control group left cerebrospinal fluid samples when they were under spinal anesthesia,and the NSE expression level was detected and the expression of NSE was compared with the change of the expression.The patients in the study group were divided into groups according to etiology,NIHSS score and GOS score,and compared the NSE expression level in cerebrospinal fluid of each subgroup.Results The expression level of NES in cerebrospinal fluid of the study group began to increase on the 1st day after onset,reached the peak on the 3^(rd) to 5^(th) day,and then gradually decreased,and the normal level was basically recovered on the 14^(th) day.There was no significant difference in the expression of NSE in cerebrospinal fluid between different etiological subgroups in the study group(P>0.05);There was significant difference in NSE expression in CSF between different NIHSS and GOS score subgroups(P<0.05).Conclusion NSE expression level in cerebrospinal fluid of SAH patients increased after onset,and reached the peak on the 3^(rd )to 5^(th) day. The expression level of NES was related to the degree of nerve damage and prognosis, which could be used as the index of neurological function damage and prognosis assessment.