骨桥蛋白与高血压性脑出血脑组织水肿程度和神经功能损伤及临床预后的相关性分析  

Study on the correlations between osteopontin and the degree of brain edema and neurological impairment in hypertensive intracerebral hemorrhage and clinical prognosis

作　　者：魏宏敏 于继徐 柴永宏 李越 李伟[1] 刘振川 车峰远[1] Wei Hongmin;Yu Jixu;Chai Yonghong;Li Yue;Li Wei;Liu Zhenchuan;Che Fengyuan(Department of Neurology,11th Affiliated Clinical Medical College of Qingdao University,Linyi People's Hospital,Linyi 276000,China;Department of Internal Medicine,Shandong Medical College,Linyi 276000,China)

机构地区：[1]青岛大学第十一临床医学院临沂市人民医院神经内科,276000 [2]山东医学高等专科学校内科学教研室,临沂276000

出　　处：《神经疾病与精神卫生》2020年第12期843-848,共6页Journal of Neuroscience and Mental Health

基　　金：临沂市科技发展计划(201919010)。

摘　　要：目的 观察高血压性脑出血(HICH)患者骨桥蛋白(OPN)的表达及其与脑组织水肿程度、神经功能损伤及临床预后之间的关系.方法 收集临沂市人民医院神经内科监护室自2017年4月至2018年11月收治的HICH患者17例为观察组,通过立体定向软通道颅内血肿清除术取其血肿液,并同时抽取患者外周血.测量观察组脑组织出血量、水肿量,并评估术前格拉斯哥昏迷量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分,术后3个月改良Rankin量表(mRS)评分.收集临沂市人民医院14例健康体检者为对照组,取其空腹外周血.利用酶联免疫吸附剂测定(ELISA)法检测观察组血肿液、外周血和健康对照组外周血OPN水平,分析OPN表达水平与患者脑水肿程度、神经功能损伤及临床预后之间的关系.结果 观察组患者血肿液中OPN水平高于患者外周血[(2653.48±1460.64)μg/L比(1313.00±950.89)μg/L],差异有统计学意义(t=4.752,P<0.001).观察组患者外周血OPN水平与对照组外周血[(1313.00±950.89)μg/L比(923.44±284.73)μg/L]差异无统计学意义(t=1.475,P=0.151).轻中度、重度神经功能障碍组血肿液OPN水平分别为(1708.87±1227.78)、(3716.16±846.08)μg/L,差异有统计学意义(t=3.872,P=0.002).轻、中、重度意识障碍组血肿液OPN水平差异有统计学意义[(1378.30±626.26)μg/L比(1798.04±1518.76)μg/L比(3507.14±1000.53)μg/L;F=4.987,P=0.023].少量、大量脑水肿组血肿液OPN水平差异有统计学意义[(1418.08±851.40)μg/L比(3751.61±865.90)μg/L,t=5.590,P<0.001].预后良好、预后不良组血肿液OPN水平差异有统计学意义[(2006.46±994.69)μg/L比(3882.90±482.28)μg/L;t=4.232,P=0.001].血肿液OPN浓度与水肿量(r=0.616,P=0.008)、发病时GCS评分(r=0.491,P=0.045)、发病时NIHSS评分(r=0.491,P=0.046)、术后3个月mRS评分(r=0.581,P=0.029)均呈正相关.结论 OPN与HICH患者病情严重程度及预后具有相关性,血肿液中OPN水平越高,病情越重,预�Objective To observe the expression of osteopontin(OPN)in patients with hypertensive intracerebral hemorrhage(HICH)and its relationship with the brain edema,neurological impairment and clinical prognosis.Methods A total of 17 patients with HICH admitted to the medical intensive care unit of Neurology Department of Linyi People's Hospital were collected as observation group.The hematoma fluid was extracted through stereotactic soft-channel intracranial hematoma evacuation,and the peripheral blood was extracted simultaneously.The amount of hematoma and edema in the observation group were measured,and the preoperative Glasgow Coma Scale(GCS)score,National Institutes of Health Stroke Scale(NIHSS)score were evaluated.The modified Rankin Scale(mRS)score were evaluated 3 months after operation.A total of 14 healthy people who took physical examination in Linyi People's Hospital were collected as control group,and the fasting peripheral blood was collected.Enzyme linked immunosorbent assay(ELISA)was used to detect the levels of OPN in hematoma fluid and peripheral blood of observation group,and peripheral blood of control group.The relationship between the expression level of OPN and the brain edema,neurological impairment and clinical prognosis was analyzed.Results The level of OPN in hematoma fluid of observation group was higher than that in peripheral blood[(2653.48±1460.64)μg/L vs.(1313.00±950.89)μg/L],the difference was statistically significant(t=4.752,P<0.001).There was no statistically significant difference in OPN level between the observation group and the control group[(1313.00±950.89)μg/L vs.(923.44±284.73)μg/L;t=1.475,P=0.151].The OPN levels of hematoma fluid in mild to moderate and severe neurological dysfunction groups were(1708.87±1227.78)μg/L and(3716.16±846.08)μg/L respectively,and the difference was statistically significant(t=3.872,P=0.002).There was statistically significant difference in OPN level of among mild,moderate and severe disturbance of consciousness groups[(1378.30±626.26)μg

关 键 词：脑出血 骨桥蛋白 神经功能损伤 

分 类 号：R743.34[医药卫生—神经病学与精神病学]