脑出血急性期血清神经递质及应激激素变化与继发性脑损伤的关系

Relationship between changes of serum neurotransmitters and stress hormones and secondary brain injury during acute cerebral hemorrhage

目的 探讨脑出血急性期血清神经递质及应激激素变化与继发性脑损伤(SBI)的关系。方法 回顾性分析2020年1月至2023年12月宿迁医院收治的149例脑出血患者的资料,根据脑出血患者治疗后5 d后是否发生SBI分为并发SBI组、未并发SBI组,测定患者治疗前、治疗3 d的血清神经递质及应激激素。比较并发SBI组、未并发SBI组血清神经递质及应激激素水平,分析影响SBI发生的因素,分析血清神经递质及应激激素预测脑出血患者并发SBI的价值。结果 logistic回归分析显示急性生理与慢性健康状况评分Ⅱ、脑出血量、γ-氨基丁酸(GABA)水平、促肾上腺皮质激素释放激素(CRH)水平是脑出血患者并发SBI的影响因素(P<0.05)。ROC曲线结果显示,GABA、CRH及二者联合预测脑出血患者并发SBI的灵敏度分别为68.29%、70.73%、85.37%,特异度分别为70.37%、72.22%、89.81%,AUC分别为0.708(95%CI:0.604~0.813)、0.711(95%CI:0.597~0.825)、0.882(95%CI:0.812~0.951)。结论 血清神经递质GABA及应激激素CRH与脑出血患者并发SBI有关,二者联合预测脑出血患者并发SBI效能良好。

Objective To investigate the relationship between the changes of serum neurotransmitters and stress hormones and secondary brain injury(SBI)in acute stage of cerebral hemorrhage.Methods The data of 149 patients with intracerebral hemorrhage admitted to the hospital from January 2020 to December 2023 were retrospectively analyzed.The patients with intracerebral hemorrhage who developed SBI 5 days after treatment were divided into the group with SBI and the group without SBI.Serum neurotransmitters and stress hormones were mea⁃sured before treatment and 3 days after treatment.The levels of serum neurotransmitters and stress hormones in patients with and without SBI were compared,the factors affecting the occurrence of SBI were analyzed,and the value of serum neurotransmitters and stress hormones in predicting the occurrence of SBI in patients with cerebral hemorrhage was analyzed.Results Logistic regression analysis showed acute physiological and chronic health status scoreⅡ,cerebral hemorrhage volume,gamma-aminobutyric acid(GABA)level and adrenocorticotropin releasing hormone(CRH)were the factors affecting the complication of SBI in patients with cerebral hemorrhage(P<0.05).ROC curve analysis results showed that the sensitivity of GABA,CRH and their combined prediction of SBI in patients with cerebral hemorrhage were 68.29%,70.73%and 85.37%,the specificity was 70.37%,72.22%and 89.81%,and the AUC was 0.708(95%CI:0.604~0.813),0.711(95%CI:0.597~0.825),0.882(95%CI:0.812~0.951).Conclusion Serum neurotransmitter GABA and stress hormone CRH are related to the complication of SBI in patients with cerebral hemorrhage,and the combination of GABA and CRH is effective in predicting the complication of SBI in patients with cerebral hemorrhage.