血清神经元特异性烯醇化酶水平评估脑卒中昏迷患者神经功能缺损及智力和日常活动能力恢复  

Evaluating neurologic impairment and the recuperative sensibility of intelligence and ability of daily activities in patients with stroke coma by using the level of serum neuron-specific enolase

作　　者：苑振云[1] 籍文强[1] 李庆威[1] 

机构地区：[1]河北医科大学第一医院急诊科,河北省石家庄市050031

出　　处：《中国临床康复》2005年第29期102-104,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:观察脑卒中昏迷患者血清神经元特异性烯醇化酶水平的变化,探讨其变化对患者病情程度和预后的评估的敏感性能。方法:以2004-01/12河北医科大学第一医院收治的80例脑卒中昏迷患者和同期30名健康体检者作为观察对象,患者在入院后即刻、对照组在清晨空腹时抽静脉血,以放免法测定血清神经元特异性烯醇化酶;对患者的意识状态按格拉斯哥昏迷评分法进行评分,并应用直线相关法分析两者间的关系。治疗15d后,应用功能独立性评测(共18项,总分126分,108～126分为独立;72～107分轻度依赖;54～71分为中度依赖;36～53分重度依赖;18～35分为完全依赖)法评估功能恢复程度;应用韦氏成人智力量表(共11项,满分432分:>90分者为A级,智力正常;70～89分者为B级,智力低于平常;<69分者为C级,智力缺损)评估智力;应用改良爱丁堡-斯堪的那维亚评分量表(共9项,总分45分,其中0～15分为轻型、16～30分为中型、31～45为重型)评估神经功能缺损程度。结果:按意向处理分析,110例被试者全部进入结果分析。①血清神经元特异性烯醇化酶水平:脑卒中昏迷组显著高于对照组[(29.8±6.7),(3.6±2.1)μg/L,t=20.9,P<0.001];脑出血患者显著高于脑梗死患者[(32.3±2.3),(27.7±3.5)μg/L,t=6.85,P<0.01]。②血清神经元特异性烯醇酶水平与格拉斯哥昏迷量表评分呈负相关(r=-0.90,P<0.001)。③日常生活能力测评结果:功能独立性评测得分越高,血清神经元特异性烯醇化酶水平越低。④智力测评结果:A,B,C级血清神经元特异性烯醇化酶水平分别为(18.1±3.1),(25.4±1.8)和(33.7±2.9)μg/L。⑤神经功能缺损测评结果:轻、中、重型患者血清神经元特异性烯醇化酶水平分别为(19.7±2.1),(28.3±1.7)和(36.4±1.2)μg/L。结论:脑卒中昏迷患者血清神经元特异性烯醇化酶水平显著升高,是判断脑损伤程度和评价预后的一个敏感指标。AIM： To observe the changes of serum neuron-specific enolase （NSE） levels, and to explore the sensibility of its changes on the patient＇s condition and prognosis evaluation in patients with stroke coma. METHODS： Eighty patients with stroke coma from First Hospital of Hebei Medical University between January and December 2004 and 30 healthy testees at the same period were selected as observation objects. The venous blood was extracted at the moment of hospitalization of the patients and the people in control group with an empty stomach in the early morning. The serum NSE levels were measured by the method of radio-immunity. Glasgow coma score scored the patients in conscious state. The relationship of the two was analyzed by the linear correlation method. After fifteen days of treatment, the degree of functional recovery was evaluated by functional independence measure （FIM） （totally 18 items, total mark was 126 points, 108-126 points for independence, 72-107 points for mild dependence, 54-71 points for medium dependence, 36-53 points for sever dependence, 18-35 points for complete dependence）; Intelligence was evaluated by webster adult intelligence scale （WAIS） （totally 11 items, total mark was 432 points： 〉90 points for A grade, having normal intelligence; 70-89 points for B grade,having lower intelligence than the normal; 〈 69 points for C grade, having defective intelligence）; Degree of neurologic impairment was evaluated by improved edinburgh-scandinavian stroke scale （MESSS） （totally 9 items, total mark was 45 points, including 0- 15 points for mild, 16-30 points for moderate, 31-45 pionts for sever）. RESULTS： According to the intention-to-treat analysis, 110 testees were all involved in the result analysis. ① The level of serum NSE： It was significantly higher in the stroke coma group than that in the control group [（29.8±6.7）, （3.6±2.1）μg/L, t=20.9, P 〈 0. 001]. It was significantly higher in the patients with cerebral hemorrhage than that in the

关 键 词：脑血管意外 磷酸丙酮酸水合酶 格拉斯哥昏迷量表 日常生活活动 

分 类 号：R745[医药卫生—神经病学与精神病学]