血清S-100β、NES和D-D水平与高血压脑出血术后转归的相关性研究

Correlation between levels of serum S-100β, neuron-specific enolase and D-dimer and postoperative outcomes of hypertensive intracerebral hemorrhage

目的研究高血压脑出血(HICH)患者术后S-100β蛋白、神经元特异性烯醇化酶(NSE)和D-二聚体(D-D)水平变化及其与术后转归的相关性。方法选取2019年1月至2020年12月在复旦大学附属华山医院治疗的126例HICH手术患者为研究对象,均详细记录患者的年龄、出血量、破入脑室率、入院时Glasgow昏迷(GCS)评分及术后感染率等基本资料,所有患者于术后3个月时采用Glasgow预后评定量表(GOS)进行评估,并根据结果将患者分为预后良好组和预后不良组,采集所有患者入院时及术后1 d、3 d和7 d外周静脉血,采用ELISA法检测S-100β和NSE水平,采用免疫比浊法检测D-D水平,比较两组患者的年龄、出血量、破入脑室率、入院时GCS评分及术后感染率等基本资料以及手术前后的血清S-100β、NSE和D-D水平,采用Logistics回归分析研究其与预后的关系,然后作受试者工作特征(ROC)曲线并计算曲线下面积(AUC)分析血清S-100β、NSE和D-D水平预测HICH手术患者预后的临床价值。结果预后不良组患者的年龄、出血量、破入脑室率、入院时GCS评分及术后感染率分别为(63.98±9.71)岁、(62.61±14.45) m L、48.78%、(9.18±0.94)分和21.95%,明显高于预后良好组的(56.94±10.26)岁、(56.83±13.29) m L、27.06%、(8.79±0.85)分和8.24%,差异均有统计学意义(P<0.05);两组患者术后的血清S-100β、NSE和D-D水平明显降低,且预后不良组患者术后3 d和7 d时的血清S-100β水平分别为(1.19±0.35) ng/mL和(0.91±0.20) ng/mL,血清NSE水平分别为(14.03±3.92) ng/mL和(10.53±3.17) ng/mL,血清D-D水平分别为(7.85±1.74)μg/L和(5.48±0.84)μg/L,明显高于预后良好组的(1.05±0.31) ng/mL和(0.72±0.23) ng/mL,(12.36±3.74) ng/mL和(8.45±2.61) ng/mL,(7.12±1.83)μg/L和(4.76±0.69)μg/L,差异均有统计学意义(P<0.05);HICH患者术后3 d时血清S-100β(r=-0.261)和NSE (r=-0.238)水平以及术后7 d时血清S-100β(r=-0.402)、NSE (r=-0.376)和D-D (r=-0.318)水平与GOS评分呈明显负相关性(P<0.05);Logistics回归分析结果显示,术后7 d时血清S-100β(OR=1.130,95%CI:1.030~1.239)、NSE (OR=1.224,95%CI:1.041~1.439)和D-D (OR=1.665,95%CI:1.150~2.412)水平与HICH患者预后存在密切联系(P<0.05);术后7 d时血清S-100β、NSE和D-D水平预测HICH患者预后不良的AUC分别为0.731、0.733和0.757,三者联合检测AUC为0.859。结论 HICH患者术后血清S-100β、NSE和D-D水平明显降低,且与患者术后转归存在密切联系,可为评估手术效果提供参考依据。

Objective To study the postoperative changes of S-100β protein, neuron-specific enolase(NSE and D-dimer(D-D) in patients with hypertensive intracerebral hemorrhage(HICH) and their correlation with postoperative outcomes. Methods A total of 126 patients undergoing HICH surgery in Huashan Hospital Affiliated to Fudan University between January 2019 and December 2020 were selected as the study subjects. The basic data such as age, bleeding volume, rate of breaking into ventricles, Glasgow Coma Score(GCS) at admission and postoperative infection rate were recorded in detail. All the patients were evaluated by using the Glasgow Outcome Scale(GOS) at 3 months after surgery, and they were divided into good prognosis group and poor prognosis group according to the above results. The peripheral venous blood was collected at admission and at 1 d, 3 d, 7 d after surgery, and the levels of S-100β and NSE were determined by ELISA and the D-D level was detected by immunoturbidimetry. The basic data of age, bleeding volume, rate of breaking into ventricles, GCS score at admission and postoperative infection rate and levels of serum S-100β,NSE and D-D before and after surgery were compared between the two groups, and their relationship with prognosis was explored by logistics regression analysis. Receiver operating characteristic(ROC) curve was drawn and area under the curve(AUC) was calculated to analyze the clinical value of serum S-100β, NSE and D-D in predicting the prognosis of patients undergoing HICH surgery. Results The age, bleeding volume, rate of breaking into ventricles, GCS score at admission and postoperative infection rate of poor prognosis group were(63.98 ± 9.71) years old,(62.61 ± 14.45) mL,48.78%,(9.18 ± 0.94) points, and 21.95%, respectively, which were significantly higher than corresponding(56.94 ±10.26) years old,(56.83±13.29) m L, 27.06%,(8.79±0.85) points, and 8.24% of good prognosis group(all P<0.05). The levels of serum S-100β, NSE and D-D were significantly reduced in the two groups of patients after surgery(P<0.05),and at 3 d and 7 d after surgery, the levels of serum S-100β, serum NSE and serum D-D in poor prognosis group were(1.19±0.35) ng/mL and(0.91±0.20) ng/mL,(14.03±3.92) ng/m L and(10.53±3.17) ng/mL,(7.85±1.74) μg/L and(5.48±0.84) μg/L, respectively, which were significantly higher than corresponding(1.05±0.31) ng/mL and(0.72±0.23) ng/mL,(12.36±3.74) ng/mL and(8.45±2.61) ng/mL,(7.12±1.83) μg/L and(4.76±0.69) μg/L in good prognosis group(all P<0.05). Serum S-100β(r=-0.261) and NSE(r=-0.238) at 3 d after surgery and serum S-100β(r=-0.402), NSE(r=-0.376)and D-D(r=-0.318) at 7 d after surgery in patients with HICH were significantly negatively correlated with GOS score(all P<0.05). Logistics regression analysis showed that levels of serum S-100β(OR=1.130, 95%CI:1.030-1.239), NSE 9(OR=1.224, 95%CI: 1.041-1.439) and D-D(OR=1.665, 95%CI: 1.150-2.412) at 7 d after surgery were closely related to the prognosis of patients with HICH(all P<0.05). The AUC values of serum S-100β, NSE and D-D at 7 d after surgery in predicting poor prognosis of patients with HICH were 0.731, 0.733 and 0.757 respectively, and the AUC of the combination of the three was 0.859. Conclusion The levels of serum S-100β, NSE and D-D in patients with HICH are significantly reduced after surgery, and they are closely related to the postoperative outcomes, which can provide a reference for evaluating the surgical effect.