高血压脑出血行神经内镜微创术患者血清NSE Cys-C水平与预后的相关性研究  

Study of the correlation of serum NSE and Cys-C in HICH patients treated by neuroendoscopic minimally invasive surgery and the prognosis

作　　者：吕国伟 姜羽 辛孟杰 张文进 张辉 朱旭强[2] LYU Guowei;JIANG Yu;XIN Mengjie;ZHANG Wenjin;ZHANG Hui;ZHU Xuqiang(Zhengzhou Central Hospital,Zhengzhou University,Zhengzhou 450000,China;The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学附属郑州中心医院,河南郑州450000 [2]郑州大学第一附属医院,河南郑州450052

出　　处：《中国实用神经疾病杂志》2020年第24期2157-2163,共7页Chinese Journal of Practical Nervous Diseases

基　　金：河南省高等学校重点科研项目(编号:19A320041)。

摘　　要：目的分析神经内镜微创术对高血压脑出血(HICH)患者血清神经元特异性烯醇化酶(NSE)、胱抑素C(Cys-C)的影响及其与预后的相关性。方法回顾性分析2016-01—2019-01郑州大学附属郑州中心医院就诊的高血压脑出血患者78例,均行神经内镜微创手术,根据格拉斯哥预后评分(GOS),术后4~5分患者49例为预后良好组,1~3分患者29例为预后不良组,分析术后NSE及Cys-C变化及预后危险因素。结果术后患者血清NSE、Cys-C水平均下降,且预后良好组均低于预后不良组(P<0.05)。以术后血清NSE、Cys-C预测患者预后不良时,两项指标联合的AUC最大为0.836,高于单一的NSE、Cys-C的0.788、0.737(P<0.05);单因素分析显示,年龄、出血量、出血破入脑室、入院时GCS评分、NSE、Cys-C与患者预后不良显著相关(P<0.05);多因素分析显示,年龄≥60岁、出血量≥50 mL、出血破入脑室、入院时GCS评分≤6分、NSE≥10.827μg/mL、Cys-C≥1.545 mg/L是患者预后不良的独立危险因素。结论神经内镜微创术后HICH患者NSE、Cys-C水平均降低,多因素分析表明年龄≥60岁、脑出血量≥50 mL、出血破入脑室、入院时GCS评分≤6分、术后NSE≥10.827μg/mL、Cys-C≥1.545 mg/L是患者预后不良的独立危险因素,临床应重视监测患者NSE、Cys-C水平,以改善患者预后。Objective To explore the effects of neuroendoscopic minimally invasive surgery on serum neuron-specific enolase(NSE)and cystatin C(Cys-C)in patients with hypertensive intracerebral hemorrhage(HICH)and their correlation with prognosis.Methods A total of 78 HICH patients who were treated in the hospital from January 2016 to January 2019 were retrospectively analyzed.All underwent neuroendoscopic minimally invasive surgery.According to different scores of Glasgow outcome scale(GOS),49 patients scoring 4 and 5 points were enrolled as good prognosis group,while 29 patients scoring 1-3 points were enrolled as poor prognosis group.The changes of postoperative NSE and Cys-C,as well as the risk factors of prognosis were explored.Results After surgery,the levels of serum NSE and Cys-C in both groups were decreased,which were lower in good prognosis group than poor prognosis group(P<0.05).AUC of serum NSE combined with Cys-C for predicting poor prognosis was greater than that of NSE and Cys-C alone(0.836 vs 0.788,0.737)(P<0.05).Univariate analysis showed that age,blood loss,bleeding into ventricle,GCS score at admission,NSE and Cys-C were significantly correlated with poor prognosis(P<0.05).Multivariate analysis showed that age not lower than 60 years old,cerebral blood loss not less than 50mL,bleeding into ventricle,GCS score at admission not higher than 6 points,NSE not lower than 10.827μg/mL and Cys-C not lower than 1.545mg/L were independent risk factors of poor prognosis.Conclusion After neuroendoscopic minimally invasive surgery,levels of NSE and Cys-C are decreased in HICH patients.Multivariate analysis shows that age not lower than 60 years old,cerebral blood loss not less than 50mL,bleeding into ventricle,GCS score at admission not higher than 6 points,NSE not lower than 10.827μg/mL and Cys-C not lower than 1.545mg/L are independent risk factors of poor prognosis.Clinically,monitoring of NSE and Cys-C levels should be payed attention to so as to improve patients prognosis.

关 键 词：高血压脑出血 神经内镜微创术 神经元特异性烯醇化酶 胱抑素C 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]