UCH-L1和GFAP对硬膜外血肿进展的预测价值

Value of ubiquitin C-terminal hydrolase-L1 and glial fibrillary acidic protein in predicting the progression of epidural hematoma

目的探讨泛素C末端水解酶-L1(UCH-L1)和胶质纤维酸性蛋白(GFAP)在预测硬膜外血肿(EDH)进展中的价值。方法将雄性新西兰白兔随机分为假手术组(SH组)和EDH0.1、0.2、0.3mL组,每组各24只。于术后1、3、6、24h采血,采用酶联免疫吸附试验法测定血浆中UCH-L1、GFAP的水平。术后24h进行神经行为学评分、脑含水量检测,采用免疫组织化学法检测大脑皮质中UCH-L1及GFAP的表达。结果与SH组相比,EDH各组的神经行为学评分降低(F=290.10,P<0.001)、脑含水量增加(F=33.64,P<0.001)。4组兔大脑皮质中UCH-L1和GFAP的差异有统计学意义(F=45.90、118.03,P<0.001)。EDH各组血浆UCH-L1水平在术后1、3、6h高于SH组(F=3.15~47.93,P<0.001),血浆GFAP水平在术后各个时间点均高于SH组(F=29.17~332.00,P<0.001)。结论EDH体积增大可以促进损伤侧大脑皮质中UCH-L1和GFAP的表达,上调血浆中二者的水平。大脑皮质和血浆中的UCH-L1和GFAP可作为预测EDH进展的有效生物标志物。

Objective To investigate the value of ubiquitin C-terminal hydrolase-L1(UCH-L1)and glial fibrillary acidic protein(GFAP)in predicting the progression of epidural hematoma(EDH).Methods Male New Zealand white rabbits were randomly divided into sham-operation group(SH group),EDH 0.1 mL group,EDH 0.2 mL group,and EDH 0.3 mL group.Blood samples were collected at 1,3,6,and 24 h after surgery,and enzyme-linked immunosorbent assay was used to measure the levels of UCH-L1 and GFAP in plasma.Neurobehavioral scoring and brain water content measurement were performed at 24 h after surgery,and immunohistochemistry was used to measure the expression of UCH-L1 and GFAP in cerebral cortex.Results Compared with the SH group,the three EDH groups had a significant reduction in neurobehavioral score(F=290.10,P<0.001)and a significant increase in brain water content(F=33.64,P<0.001).There were significant differences in UCH-L1 and GFAP in cerebral cortex between the four groups(F=45.90,118.03;P<0.001).Compared with the SH group,the three EDH groups had a significantly higher level of UCH-L1 in plasma at 1,3,and 6 h after surgery(F=3.15-47.93,P<0.001)and a significantly higher level of GFAP in plasma at each time point after surgery(F=29.17-332.00,P<0.001).Conclusion An increase in EDH volume can promote the expression of UCH-L1 and GFAP in the injured cortex and upregulate the levels of UCH-L1 and GFAP in plasma.UCH-L1 and GFAP in cerebral cortex and plasma can be used as effective biomarkers for predicting the progression of EDH.