血清S-100B蛋白和一氧化氮检测对急性脑出血的临床评价价值

2019-12-16 08:14王小蓉杨友京王显斌罗小兰
中国当代医药 2019年28期
关键词:脑出血血清蛋白

王小蓉 杨友京 王显斌 罗小兰

[摘要]目的 探討血清S-100B蛋白和一氧化氮(NO)检测对急性脑出血的临床评价价值,分析其与急性脑出血患者的临床症状、体征及预后之间的关系。方法 选取2009年1月~2014年1月我院收治的80例急性脑出血患者作为急性脑出血组,选取同期在我院体检的80例健康体检者作为对照组。利用多田公式根据急性脑出血组患者入院头颅CT片计算脑出血血肿体积,再将其分为小量出血组(25例),中量出血组(32例)及大量出血组(23例)。所有患者按照美国国立卫生研究院脑卒中量表(NIHSS)评估神经功能缺损状况,再将0~15分作为预后良好组(52例),16~42分作为预后恶劣组(28例)。采用酶联免疫吸附测定法(ELISA)和硝酸还原酶法动态检测血清S-100B蛋白和NO含量变化;采用Pearson相关性分析血清S-100B蛋白和NO含量与出血量的相关性。结果 脑出血第1天,急性脑出血组的血清S-100B蛋白与NO含量高于对照组,差异有统计学意义(P<0.05);急性脑出血组脑出血第3、7、10天的血清S-100B蛋白与NO含量高于脑出血第1天,差异有统计学意义(P<0.05);急性脑出血组的血清S-100B蛋白含量与NO含量在脑出血第3天高于第7、10天,差异有统计学意义(P<0.05)。小量出血组的第1、3、7、10天的血清S-100B蛋白和NO含量低于中量出血组和大量出血组,中量出血组脑出血第1、3、7、10天的血清S-100B蛋白和NO含量低于大量出血组,差异均有统计学意义(P<0.05)。脑出血第1天,预后恶劣组和预后良好组的血清S-100B蛋白和NO含量比较,差异无统计学意义(P>0.05);预后恶劣组的血清S-100B蛋白和NO含量在脑出血第3、7、10天高于脑出血第1天,差异有统计学意义(P<0.05);预后恶劣组在脑出血第3、7、10天的血清S-100B蛋白和NO含量高于预后良好组,差异有统计学意义(P<0.05)。经Pearson相关性分析发现,血清S-100B蛋白和NO含量与出血量均成正相关(r1=0.76,r2=0.72,P<0.05),且急性脑出血组患者的血清S-100B蛋白和NO含量也成正相关(r=0.529,P<0.05)。结论 血清S-100B蛋白与NO检测在急性脑出血脑损伤中起着重要作用,临床上可将血清S-100B蛋白和NO检测作为脑出血急性期病情变化的动态观察指标之一,用以估计预后、指导治疗。

[关键词]脑出血;血清S-100B蛋白;一氧化氮;脑损伤;临床评价

[中图分类号] R743          [文献标识码] A          [文章编号] 1674-4721(2019)10(a)-0060-05

[Abstract] Objective To explore the clinical value of serum S-100B protein and NO detection in acute cerebral hemorrhage, and to analyze the relationship with clinical symptoms, signs and prognosis of patients with acute cerebral hemorrhage by serum S-100B protein and NO detection. Methods A total of 80 patients with acute cerebral hemorrhage admitted to our hospital from January 2009 to January 2014 were selected as the acute cerebral hemorrhage group, and 80 healthy people who underwent physical examination in our hospital during the same period were selected as the control group. The volume of hematoma of cerebral hemorrhage was calculated by the Doda formula on the basis of head CT films. According to the size of hematoma, 25 patients were divided into small hemorrhage group, 32 patients in medium hemorrhage groupand 23 patients in large hemorrhage group. Neurological deficits were assessed using the national institutes of health stroke inventory (NIHSS). Then 0 to 15 points were used as the group with good prognosis (52 cases), 16 to 42 points as poor prognosis group (28 cases). The concentration of S-100B protein and NO content were detected dynamically by ELISA and nitrate reductase methods, respectively. Results On the first day of cerebral hemorrhage, serum S-100B protein and NO content in the acute cerebral hemorrhage group were higher than that in the control group, and the differences were statistically significant (P<0.05). The serum S-100B protein and NO content on the 3rd, 7th and 10th days of acute cerebral hemorrhage group were higher than that on the 1st day of cerebral hemorrhage, and the difference were statistically significant (P<0.05); The serum S-100B protein content and NO content in the acute cerebral hemorrhage group in the 3 rd day after cerebral hemorrhage was higher than those in the 7th and 10th days after cerebral hemorrhage, and the differences were statistically significant (P<0.05). The serum S-100B protein and NO content on the 3rd, 7th and 10th day in the small amount of bleeding group were lower than that in the medium amount of bleeding group and the large amount of bleeding group, and the serum S-100B protein and NO content on the 3rd, 7th and 10th day in the medium amount of bleeding group were lower than those in the large amount of bleeding group, the differences were statistically significant (P<0.05). On the first day of cerebral hemorrhage, there was no significant difference in serum S-100B protein and NO content between the poor prognosis group and the good prognosis group (P>0.05). The serum S-100B protein and NO content in the poor prognosis group on the 3rd, 7th and 10th day of cerebral hemorrhage were higher than those in the first day of cerebral hemorrhage, and the differences were statistically significant (P<0.05). The serum S-100B protein and NO content in the poor prognosis group on the 3rd, 7th and 10th day of cerebral hemorrhage were higher than those in the group with good prognosis, and the differences were statistically significant (P<0.05). Pearson correlation analysis showed that serum S-100B protein and NO content were positively correlated with blood loss (r1=0.76, r2=0.72, P<0.05), and serum S-100B protein and NO content in patients with acute cerebral hemorrhage. It was also positively correlated (r=0.529, P<0.05). Conclusion Serum S-100B protein and NO detection plays an important role in brain injury after acute cerebral hemorrhage. The determination of serum S-100B protein and NO detection can be used as one of the dynamic indicators to observe the changes of acute cerebral hemorrhage in order to estimate the prognosis and guide the treatment.

Pearson相关性分析显示,急性脑出血组的血清S-100B蛋白和NO含量成正相关(r=0.529,P<0.05)。

3讨论

血清S-100蛋白于1965年被Moore BW发现,目前为止,已有21个家族成员被陆续发现[12]。该蛋白由α、β两种亚基组成。血清S-100B蛋白是胶质细胞与神经元之间相互作用的桥梁,是一类由星形胶质细胞分泌的细胞因子[13],它是神经胶质细胞的标志性蛋白[14],极易透过血脑屏障。正常人血清中含量极低且相当稳定,当各种原因导致脑组织受损、血脑屏障破坏,由此产生的大量血清S-100B蛋白透过血脑屏障,导致血清S-100B蛋白含量升高。因此,通过检测外周血中S-100B蛋白含量可反映脑损害的严重程度[15]。

本次研究提示,急性脑出血组的血清S-100B蛋白高于对照组,差异有统计学意义(P<0.05);急性脑出血组脑出血第3、7、10天的血清S-100B蛋白高于脑出血第1天,差异有统计学意义(P<0.05);急性脑出血组在脑出血第3天的血清S-100B蛋白含量高于第7、10天,差异有统计学意义(P<0.05);小量出血组在脑出血第1、3、7、10天的血清S-100B蛋白低于中量出血组和大量出血组,中量出血组在脑出血第1、3、7、10天的血清S-100B蛋白低于大量出血组,差异均有统计学意义(P<0.05);预后恶劣组在脑出血第3、7、10天的血清S-100B蛋白高于预后良好组,差异有统计学意义(P<0.05)。因此,检测血清中S-100B蛋白,可以不同程度地反映脑出血患者病情的严重程度,用以指导治疗,估计临床预后[10]。

NO是在一氧化氮合酶(NOS)催化下生成的,在体内扮演着生理和病理的双重角色。脑内NO既可起脑保护作用,又有神经细胞毒性作用。生理量时,NO具有调节血管紧张度、调节凝血过程、介导炎症反应、参与氧化等的作用;在中枢神经系统中,NO主要促进递质释放,参与突触可逆性过程,调节血脑屏障的通透性,参与脑的高级功能活动等。高浓度的NO具有细胞毒性作用,可以加重缺血性脑组织损伤。本次研究发现,发病第1天,急性脑出血组的血清NO含量含量高于对照组,差异有统计学意义(P<0.05);急性脑出血组发病第3、7、10天血清NO含量高于发病第1天,差异有统计学意义(P<0.05);急性脑出血组在脑出血第3天的NO含量含量高于第7、10天,差异有统计学意义(P<0.05);小量出血组在脑出血第1、3、7、10天的NO含量低于中量出血组和大量出血组,中量出血组在脑出血第1、3、7、10天的NO含量低于大量出血组,差异均有统计学意义(P<0.05);预后恶劣组在脑出血第3、7、10天的NO含量高于预后良好组,差异有统计学意义(P<0.05)。血清NO含量出现上述变化,可能由于:①脑出血后的应激状态激活和增加了诱导型NO合成酶的活性,产生过量的NO;②过量的NO介导了Glu-Ca-NOS通道,合成过量的NO;③脑出血后,在大量白细胞浸润以及血红蛋白代谢产物的影响下,也可诱导组织高表达诱导型NO合酶,进而介导NO的分泌含量增高。上述过程产生的大量NO,既介导严重的损伤性炎症瀑布效应,也导致血脑屏障严重破坏,导致脑损伤加重、患者病情重、预后差[16-17]。而且脑出血时,产生的大量NO致血脑屏障严重破坏时,本身会导致血清S-100B蛋白大量渗出,高浓度的血清S-100B蛋白也可以促进致炎因子NO增多[18],导致脑损伤加重。尤其出血量大时,通过各种损伤途径产生的NO量更多,血脑屏障破坏更严重,通过破坏的血脑屏障渗出的血清S-100B蛋白也更多,促使致炎因子NO产生增多,可能最终导致出血量大的患者病情更重,预后更差。经Pearson相关性分析发现,急性腦出血组的血清S-100B蛋白和NO含量成正相关(r=0.529,P<0.05),提示血清S-100B蛋白与NO含量在脑出血后脑损伤的发生、发展过程中可能起着重要作用,二者可能互为因果,介导了脑出血后的损伤过程。

综上所述,对于急性脑出血患者,可结合临床症状、头影像学检查结果及血清S-100B蛋白和NO检测结果,综合判断病情严重程度,估计预后。因此,临床上可将血清S-100B蛋白和NO含量检测作为脑出血急性期病情变化的动态观察指标之一,但尚缺乏大样本的临床资料。

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(收稿日期:2018-11-05本文編辑:焦曌元)

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