颅内压联合血清热休克蛋白47检测对高血压脑出血患者神经功能缺损及预后评估的价值  

Value of intracranial pressure combined with serum heat shock protein 47 detection in the evaluation of nerve defect and prognosis in hypertensive intracerebral hemorrhage patients

作　　者：罗建利[1] 苟淋 桂先正 LUO Jianli;GOU Lin;GUI Xianzheng(Department of Neurosurgery,Bazhong Central Hospital,Bazhong 636000,China)

机构地区：[1]巴中市中心医院神经外科,四川巴中636000

出　　处：《山东医药》2023年第31期6-9,共4页Shandong Medical Journal

基　　金：四川省卫生健康科研课题(20PJ230)。

摘　　要：目的探讨颅内压(ICP)联合血清热休克蛋白47(HSP47)检测对高血压脑出血(HICH)患者神经功能缺损及预后评估的价值。方法选择109例HICH患者,均行急诊软通道微创颅内血肿穿刺引流术,术后监测ICP,获得波幅(AMP)和压力波幅相关性指数(RAP);术前用ELISA法检测血清HSP47;收集患者临床资料。采用美国国立卫生研究院卒中量表评分对患者神经功能缺损进行评价,并将患者分为轻型组32例(<7分)、中型组48例(7~15分)、重型组29例(>15分);出院后6个月根据格拉斯哥预后评分将患者分为预后不良组(1~3分)44例、预后良好组(4~5分)65例。单因素与多因素Logistic回归分析HICH患者预后不良的影响因素;受试者工作特征曲线分析ICP参数联合血清HSP47预测HICH患者预后的价值。结果重型组AMP、RAP、血清HSP47水平高于中型组、轻型组(P均<0.05),中型组AMP、RAP、血清HSP47水平高于轻型组(P均<0.05)。单因素分析结果显示,预后不良组入院时格拉斯哥昏迷量表(GCS)评分、出血量≥50 mL比例、术后再发脑出血比例、AMP、RAP、血清HSP47水平均高于预后良好组(P均<0.05)。多因素Logistic回归分析结果显示,入院时GCS评分高、AMP高、RAP高、HSP47高是HICH患者预后不良的危险因素(P均<0.05)。AMP、RAP、HSP47预测HICH患者预后不良的曲线下面积分别为0.776、0.793、0.774,三者联合预测HICH患者预后不良的曲线下面积为0.920,高于单独预测(P均<0.05)。结论ICP参数AMP、RAP及血清HSP47水平升高与HICH患者神经功能缺损加重和不良预后有关,三者联合可提高对HICH患者预后的预测效能。Objective To evaluate the value of intracranial pressure(ICP)monitoring combined with serum heat shock protein 47(HSP47)detection in the evaluation of nerve defect and prognosis of hypertensive intracerebral hemorrhage(HICH)patients.Methods Totally 109 patients with HICH were selected,all of whom underwent emergency soft-channel minimally invasive intracranial hematoma puncture and drainage.ICP was monitored after operation,and amplitude(AMP)and pressure amplitude correlation index(RAP)were obtained.Serum HSP47 was detected by ELISA before operation.Clinical data of patients were collected.The nerve defect was evaluated by the National Institutes of Health Stroke Scale(NIHSS),and the patients were divided into the mild group of 32 cases(<7 points),moderate group of 48 cases(7-15 points),and severe group of 29 cases(>15 points).At six months after discharge,the patients were divided into the poor prognosis group(44 cases)(1-3 points)and good prognosis group(65 cases)(4-5 points)according to Glasgow prognosis score(GOS).Univariate and multivariate Logistic regression were used to analyze the influencing factors of poor prognosis in HICH patients.The value of ICP parameters combined with serum HSP47 in predicting the prognosis of patients with HICH was analyzed by receiver operating characteristic curve.Results The levels of AMP,RAP and HSP47 in the severe group were higher than those in the moderate group and mild group(all P<0.05),and the levels of AMP,RAP,and HSP47 in the moderate group were higher than those in the mild group(all P<0.05).Unifactorial analysis showed that the score of Glasgow Coma Scale(GCS)at admission,the proportion of blood loss≥50 mL,the proportion of recurrent cerebral hemorrhage after surgery,AMP,RAP and serum HSP47 level in the poor prognosis group were higher than those in the good prognosis group(all P<0.05).Multivariate Logistic regression analysis showed that high GCS score at admission,high AMP,high RAP,and high HSP47 were risk factors for poor prognosis in HICH patients(all P<0.05)

关 键 词：高血压脑出血 神经功能缺损 预后 颅内压 热休克蛋白47 

分 类 号：R743.34[医药卫生—神经病学与精神病学]