作者：张要田，王军宝，马昌宝，周勇

单位：

223000江苏省淮安市中医院脑外科

Units：

Department of Brain Surgery, Huai'an Hospital of Traditional Chinese Medicine, Huaian 223000, China

关键词：

　脑出血，创伤性；脑水肿；神经元特异性烯醇化酶；基质金属蛋白酶9；中性粒细胞明胶酶相关载脂蛋白

Keywords：

Brain hemorrhage, traumatic; Brain edema; Neuron specific enolase; Matrix metalloproteinase 9;Neutrophil gelatinase associated lipocalin

CLC：

R 651.15 R 742

DOI：

10.12114/j.issn.1008-5971.2023.00.288

Funds：

江苏省重点研发计划项目（BE2020617）

摘要：

目的　探讨创伤性脑出血患者脑水肿体积与血清神经元特异性烯醇化酶（NSE）、基质金属蛋白酶9（MMP-9）、中性粒细胞明胶酶相关载脂蛋白（NGAL）的关系。方法　回顾性选取2019年6月至2022年12月淮安市中医院收治的创伤性脑出血患者104例，将其作为观察组，另外选取同期于淮安市中医院体检中心体检的健康者104例作为对照组。比较观察组与对照组血清NSE、MMP-9、NGAL，创伤性脑出血患者不同时间点（脑出血后第1、3、7、14天）血清NSE、MMP-9、NGAL及脑水肿体积，脑出血后第1天不同脑水肿体积（＞4 ml和≤4 ml）创伤性脑出血患者血清NSE、MMP-9、NGAL。采用Pearson相关分析探讨脑出血后第1天创伤性脑出血患者脑水肿体积与血清NSE、MMP-9、NGAL的相关性。结果　观察组血清NSE、MMP-9、NGAL高于对照组（P＜0.05）。创伤性脑出血患者脑出血后第3、7天血清NSE、MMP-9、NGAL高于脑出血后第1天，脑水肿体积大于脑出血后第1天（P＜0.05）；创伤性脑出血患者脑出血后第7天血清NSE、MMP-9、NGAL高于脑出血后第3天，脑水肿体积大于脑出血后第3天（P＜0.05）；创伤性脑出血患者脑出血后第14天血清NSE、MMP-9、NGAL低于脑出血后第3、7天，脑水肿体积小于脑出血后第3、7天（P＜0.05）。104例创伤性脑出血患者中60例脑出血后第1天脑水肿体积＞4 ml，44例脑出血后第1天脑水肿体积≤4 ml。脑出血后第1天脑水肿体积＞4 ml者血清NSE、MMP-9、NGAL高于脑出血后第1天脑水肿体积≤4 ml者（P＜0.05）。Pearson相关分析结果显示，脑出血后第1天创伤性脑出血患者脑水肿体积与血清NSE（r=0.648，P=0.029）、MMP-9（r=0.752，P=0.021）、NGAL（r=0.639，P=0.031）呈正相关。结论　创伤性脑出血患者血清NSE、MMP-9、NGAL升高，且脑水肿体积与其呈正相关。

Abstract：

Objective To investigate the relationship between the volume of cerebral edema and serum neuronspecific enolase (NSE) , matrix metalloproteinase 9 (MMP-9) and neutrophil gelatinase associated lipocalin (NGAL) in patientswith traumatic cerebral hemorrhage. Methods A total of 104 patients with traumatic cerebral hemorrhage admitted to Huai'anHospital of Traditional Chinese Medicine from June 2019 to December 2022 were retrospectively selected as the observationgroup, and 104 healthy subjects who underwent physical examinations at the physical examination center of Huai'an Hospital ofTraditional Chinese Medicine during the same period were selected as the control group. Serum NSE, MMP-9 and NGAL werecompared between the observation group and the control group, serum NSE, MMP-9 and NGAL and brain edema volume werecompared in patients with traumatic cerebral hemorrhage at different time points (on the 1st, 3rd, 7th, 14th days after cerebralhemorrhage) , and serum NSE, MMP-9 and NGAL were compared in traumatic cerebral hemorrhage patients with differentcerebral edema volumes (> 4 ml and ≤ 4 ml) on the 1st day after cerebral hemorrhage. Prarson correlation analysis was used toinvestigate the correlation between cerebral edema volume and serum NSE, MMP-9 and NGAL in patients with traumatic cerebralhemorrhage on the 1st day after cerebral hemorrhage. Results Serum NSE, MMP-9 and NGAL in observation group were higherthan those in control group (P < 0.05) . In patients with traumatic cerebral hemorrhage, serum NSE, MMP-9 and NGAL on the3rd and 7th days after cerebral hemorrhage were higher than those on the 1st day after cerebral hemorrhage, and the volume of cerebral edema was larger than that on the 1st day after cerebral hemorrhage (P < 0.05) ; in patients with traumatic cerebralhemorrhage, serum NSE, MMP-9 and NGAL on the 7th day after cerebral hemorrhage were higher than those on the 3rd day aftercerebral hemorrhage, and the volume of cerebral edema was larger than that on the 3rd day after cerebral hemorrhage (P < 0.05) ;in patients with traumatic cerebral hemorrhage, serum NSE, MMP-9 and NGAL on the 14th day after cerebral hemorrhage werelower than those on the 3rd and 7th days after cerebral hemorrhage, and the volume of cerebral edema was smaller than that onthe 3rd and 7th days after cerebral hemorrhage (P < 0.05) . Among 104 patients with traumatic cerebral hemorrhage, 60 cases hadcerebral edema volume > 4 ml and 44 cases had cerebral edema volume ≤ 4 ml on the 1st day after cerebral hemorrhage. SerumNSE, MMP-9 and NGAL on the 1st day after cerebral hemorrhage in patients with cerebral edema volume > 4 ml were higher thanthose in patients with cerebral edema volume ≤ 4 ml (P < 0.05) . Pearson correlation analysis showed that serum NSE (r=0.648,P=0.029) , MMP-9 (r=0.752, P=0.021) and NGAL (r=0.639, P=0.031) were positively correlated with the volume of cerebraledema in patients with traumatic cerebral hemorrhage on the 1st day after cerebral hemorrhage. Conclusion Serum NSE,MMP-9 and NGAL in patients with traumatic cerebral hemorrhage are elevated, and the volume of cerebral edema is positivelycorrelated with them.

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