血清NSE水平与高血压脑出血颅内压的相关性研究

【摘要】目的探讨血清神经元特异性烯醇化酶（NSE）水平与高血压脑出血(HICH)患者颅内压的关系。方法回顾性分析83例HICH患者的临床资料，所有患者均行颅内压探头置入术进行颅内压监测。用ELISA实验检测患者血清中NSE，CD3，CD4，CD8，CD56及CD19水平。根据颅内压力将数值颅内压＜15 mmHg，15~20 mmHg，21~40 mmHg，>40 mmHg分别设为正常颅内压组，轻度颅高压组，中度颅高压组和重度颅高压组。由于正常颅内压组和重度高颅压组患者数量较少，故仅对轻度和中度颅高压组血清NSE，CD3，CD4，CD8，CD56及CD19水平进行比较，采用二分类Logistic回归分析方法分析HICH患者颅高压的相关因素。结果83例患者中，正常颅内压、轻度颅高压、中度颅高压和重度颅高压患者分别有2例、23例、54例和4例。轻度颅高压患者的出血量明显低于中度颅高压患者（19.70±5.68 vs 52.46±26.07，P＜0.001）；正常颅内压组和重度颅高压组的NSE水平分别为(8.68±1.46)ng/mL和（26.34±16.87）ng/mL。轻度颅高压患者的血清NSE水平明显低于中度颅高压患者［(9.62±4.89)ng/mL vs(14.82±10.40)ng/mL，P=0.025］。出血量和血清NSE水平与颅高压程度呈正相关。Logistic回归分析结果显示，出血量大（OR=1.26，95% CI：1.09~1.44，P=0.001），高血清NSE水平（OR=1.14，95% CI：1.02~1.26，P=0.02）患者中度颅高压的发生率明显高于低血清NSE水平患者。而年龄，性别，出血部位，血清CD3，CD4，CD8，CD56及CD19水平在两组之间无统计学差异。结论血清NSE水平与颅高压的严重程度呈正相关。

Abstract: Objective To explore the relationship between serum neuron specific enolase(NSE) level and intracranial pressure in patients with hypertensive cerebral hemorrhage(HICH). Methods The clinical data of 83 patients with HICH were analyzed retrospectively. All patients underwent intracranial pressure probe placement for intracranial pressure monitoring. Serum levels of NSE, CD3, CD4, CD8, CD56 and CD19 were detected by ELISA. The ICP ＜15 mmHg, 15~20 mmHg, 21~40 mmHg, and >40 mmHg were set as the normal ICP group, the mild ICH group, the moderate ICH group, and the severe ICH group, respectively. Due to less patients in the normal ICP group and the severe ICH group, the serum levels of NSE, CD3, CD4, CD8, CD56 and CD19 between the mild and moderate ICH groups were compared, and the related factors of ICH in patients with HICH were analyzed by binary logistic regression analysis. Results Among the 83 patients, there were 2 patients with normal intracranial pressure, 23 patients with mild intracranial hypertension, 54 patients with moderate intracranial hypertension and 4 patients with severe intracranial hypertension, respectively. The amount of bleeding of patients with mild ICH was significantly lower than that of patients with moderate ICH(19.70±5.68 vs 52.46±26.07,P＜0.001). The NSE levels of the normal ICH group and the severe ICH group were(8.68±1.46)ng/mL and(26.34±16.87)ng/mL, respectively. The serum NSE level of patients with mild ICH was significantly lower than that in patients with moderate ICH［(9.62±4.89)ng/mL vs(14.82±10.40)ng/mL，P=0.025］. The amount of bleeding and serum NSE level were positively correlated with the degree of ICH. Logistic regression analysis showed that the incidence of moderate intracranial hypertension in patients with large amount of bleeding(OR=1.26, 95% CI:1.09~1.44,P=0.001) and high serum NSE level(OR=1.14,95% CI:1.02~1.26,P=0.02) was significantly higher than that in patients with low serum NSE level. There was no significant difference in age, gender, bleeding site, serum CD3, CD4, CD8, CD56 and CD19 levels between the two groups. Conclusion Serum NSE level was positively correlated with the severity of intracranial hypertension.