亚低温辅助微创穿刺引流术对急性脑出血患者MMP-9、NSE、S100β水平及神经功能的影响

Effects of mild hypothermia assisted minimally invasive puncture drainage on MMP-9,NSE,S100β levels and neurological function inpatients with acute cerebral hemorrhage

目的 分析亚低温辅助微创穿刺引流术对急性脑出血患者基质金属蛋白酶-9(MMP-9)、神经元特异性烯醇化酶(NSE)、中枢神经特异蛋白(S100β)水平及神经功能的影响。方法 选取2021年1月至2023年1月该院收治的急性脑出血患者108例,采用随机数字表法分为研究组和对照组,每组54例。研究组给予亚低温辅助微创穿刺引流术治疗,对照组予以微创穿刺引流术治疗,随访至术后6个月。比较2组患者各时间点(术后即刻,术后3、7 d)颅内压变化情况,术前、术后7 d脑组织损伤、血清视黄醇结合蛋白4(RBP4)、粒细胞巨噬细胞集落刺激因子(GM-CSF)、人类软骨糖蛋白39(YKL-40)水平,以及术前,术后7 d、6个月神经功能和住院期间并发症发生情况。结果 与术后即刻比较,2组患者术后3、7 d颅内压均明显升高,与术后3 d比较,2组患者术后7 d颅内压均明显降低,研究组患者术后3、7 d颅内压均明显低于对照组,差异均有统计学意义(P<0.05)。与术前比较,2组患者术后7 d血清NSE、S100β、MMP-9、RBP4、GM-CSF、YKL-40水平均明显降低,且研究组患者术后7 d血清NSE、S100β、MMP-9、RBP4、GM-CSF、YKL-40水平均明显低于对照组,差异均有统计学意义(P<0.05);2组患者术后7 d格拉斯哥昏迷评分均明显升高,且研究组患者术后7 d格拉斯哥昏迷评分明显高于对照组,2组患者术后6个月美国国立卫生研究院卒中量表评分均明显降低,欧洲卒中量表评分均明显升高,且研究组患者术后6个月美国国立卫生研究院卒中量表评分明显低于对照组,欧洲卒中量表评分明显高于对照组,差异均有统计学意义(P<0.05)。2组患者住院期间并发症发生率比较,差异无统计学意义(P>0.05)。结论 亚低温辅助微创穿刺引流术可降低急性脑出血患者颅内压,调节MMP-9、NSE、S100β水平,降低脑组织损伤,调节RBP4、GM-CSF、YKL-40表达,最终改善神经功能,安全性良好。

Objective To analyze the effects of mild hypothermia assisted minimally invasive puncture and drainage on the levels of matrix metalloproteinase-9(MMP-9),neuron-specific enolase(NSE),central nervous specific protein(S100β)and neurological function in patients with acute cerebral hemorrhage.Methods A total of 108 patients with acute cerebral hemorrhage admitted to our hospital from January 2021 to January 2023 were selected and divided into the experimental group and the control group by random number table method,with 54 cases in each group.The experimental group was treated with mild hypothermia assisted minimally invasive puncture and drainage,and the control group was treated with minimally invasive puncture and drainage at each time point(immediately after operation,3 and 7 days after operation),brain tissue damage,serum retinol binding protein 4(RBP4),granulocyte macrophage colony stimulating factor(GM-CSF),human cartilage glycoprotein 39(YKL-40)levels before operation and 7 days after operation,neurological function and complications during hospitalization were compared between the two groups.Results Compared with immediately after operation,the intracranial pressure of the two groups increased significantly at 3 and 7 days after operation.Compared with 3 days after operation,the intracranial pressure of the two groups decreased significantly at 7 days after operation.The intracranial pressure of the study group was significantly lower than that of the control group at 3 and 7 days after operation,and the differences were statistically significant(P<0.05).Compared with before operation,the levels of serum NSE,S100β,MMP-9,RBP4,GM-CSF and YKL-40 in the two groups were significantly decreased on the 7 th day after operation,and the levels of serum NSE,S100β,MMP-9,RBP4,GM-CSF and YKL-40 in the study group were significantly lower than those in the control group on the 7 th day after operation,the differences were statistically significant(P<0.05).The Glasgow coma scores of the two groups were significantly increased at 7 days after operation,and the Glasgow coma scores of the study group were significantly higher than those in the control group at 7 days after operation,with statistical significance(P<0.05).Compared with the preoperative results,the scores of National Institutes of Health Stroke Scale in the two groups were significantly decreased at 6 months after operation,and the scores of European Stroke Scale were significantly increased.The scores of National Institutes of Health Stroke Scale in the study group were significantly lower than those in the control group at 6 months after operation,and the scores of European Stroke Scale were significantly higher than those in the control group,with statistical significance(P<0.05).There was no significant difference being found in the comparison of the incidence of complications during hospitalization between the two groups(P>0.05).Conclusion Mild hypothermia assisted minimally invasive puncture and drainage could reduce intracranial pressure in patients with acute cerebral hemorrhage,regulate the levels of MMP-9,NSE,S100β,reduce brain tissue damage,regulate the expression of RBP4,GM-CSF,YKL-40,and ultimately improve the effect of neurological function,with good safety.