CAJ | 학술논문

背景:CT、MRI和经颅多普勒等现代化的神经影像学技术对于脑梗死的定位和判断梗死体积有重要作用,目前尚缺乏更加简便易行的实验室检测手段.目的:观察急性脑梗死患者血清中S100-β含量与发病后脑梗死体积及预后的关系.设计:病例-对照观察.单位:山东大学山东省立医院神经内科.对象:选择2004-09/2005-08山东省立医院神经内科收治58例缺血性脑梗死患者为病例组,年龄36-86岁,平均(67.7±14.2)岁,男37例,女21例,均于出现症状24h内入组.纳入标准:诊断符合第2次全国脑血管病学术会议修订的诊断标准;全部患者均经头颅CT或磁共振等神经系统扫描检查证实符合脑梗死标准.排除标准:有脑血管病病史和/或遗留残疾.对照组50例为同期入院健康体检者,男32例,女18例,年龄43～89岁,平均(68±9)岁,2组间性别及年龄构成差异无显著性.方法:①病例组患者在入院当时及第1,2,3,4,6,10天各留取血液标本1次,对照组受试者仅在早晨空腹时留取血液标本1次.血清S100-β水平用ELISA方法测定.②病例组于患者脑梗死发作后第7天经CT及Simes Somatom所提供的软件测量梗死体积,神经功能于患者脑梗死发作后3个月评定,评定标准为修正的Rankin等级评分.主要观察指标:①两组受试者血清S100-β浓度.②病例组患者急性脑梗死发作后第7天时脑梗死体积以及脑梗死发作3个月后神经功能的评定.结果:纳入患者58例和正常对照者50例,除病例组中6例患者出现脑干反射完全消失后2月内死亡外,其余均进入结果分析.①病例组患者血清S100-β蛋白含量:逐渐增高,高峰在患者出现急性脑梗死症状后的第3天出现,为(0.61±0.13)μg/L,至第10天下降.经Post-hoc检验,脑梗死6天以内S100-β水平高于对照组,至第10天与对照组比较差异无显著性.②病例组患者血清S100-β水平:从发病开始的第1,2,3,4,6天(第10天除外)均与最终的脑梗死体积呈正相关,在第3天相关性最密切(r=0.937,P＜0.01).③病例组患者急性脑梗死3个月情况:以改良的Rankin等级评分评定其神经功能恢复情况,双变量相关分析显示血清S100-β水平与Rankin等级评分有密切的正相关性(r=0.507,P＜0.001).结论:血清中S100-β蛋白含量与急性脑梗死患者的脑梗死体积正相关,可以辅助预测急性脑梗死后神经功能恢复状况. 揹景:CT、MRI和經顱多普勒等現代化的神經影像學技術對于腦梗死的定位和判斷梗死體積有重要作用,目前尚缺乏更加簡便易行的實驗室檢測手段.目的:觀察急性腦梗死患者血清中S100-β含量與髮病後腦梗死體積及預後的關繫.設計:病例-對照觀察.單位:山東大學山東省立醫院神經內科.對象:選擇2004-09/2005-08山東省立醫院神經內科收治58例缺血性腦梗死患者為病例組,年齡36-86歲,平均(67.7±14.2)歲,男37例,女21例,均于齣現癥狀24h內入組.納入標準:診斷符閤第2次全國腦血管病學術會議脩訂的診斷標準;全部患者均經頭顱CT或磁共振等神經繫統掃描檢查證實符閤腦梗死標準.排除標準:有腦血管病病史和/或遺留殘疾.對照組50例為同期入院健康體檢者,男32例,女18例,年齡43～89歲,平均(68±9)歲,2組間性彆及年齡構成差異無顯著性.方法:①病例組患者在入院噹時及第1,2,3,4,6,10天各留取血液標本1次,對照組受試者僅在早晨空腹時留取血液標本1次.血清S100-β水平用ELISA方法測定.②病例組于患者腦梗死髮作後第7天經CT及Simes Somatom所提供的軟件測量梗死體積,神經功能于患者腦梗死髮作後3箇月評定,評定標準為脩正的Rankin等級評分.主要觀察指標:①兩組受試者血清S100-β濃度.②病例組患者急性腦梗死髮作後第7天時腦梗死體積以及腦梗死髮作3箇月後神經功能的評定.結果:納入患者58例和正常對照者50例,除病例組中6例患者齣現腦榦反射完全消失後2月內死亡外,其餘均進入結果分析.①病例組患者血清S100-β蛋白含量:逐漸增高,高峰在患者齣現急性腦梗死癥狀後的第3天齣現,為(0.61±0.13)μg/L,至第10天下降.經Post-hoc檢驗,腦梗死6天以內S100-β水平高于對照組,至第10天與對照組比較差異無顯著性.②病例組患者血清S100-β水平:從髮病開始的第1,2,3,4,6天(第10天除外)均與最終的腦梗死體積呈正相關,在第3天相關性最密切(r=0.937,P＜0.01).③病例組患者急性腦梗死3箇月情況:以改良的Rankin等級評分評定其神經功能恢複情況,雙變量相關分析顯示血清S100-β水平與Rankin等級評分有密切的正相關性(r=0.507,P＜0.001).結論:血清中S100-β蛋白含量與急性腦梗死患者的腦梗死體積正相關,可以輔助預測急性腦梗死後神經功能恢複狀況.
배경:CT、MRI화경로다보륵등현대화적신경영상학기술대우뇌경사적정위화판단경사체적유중요작용,목전상결핍경가간편역행적실험실검측수단.목적:관찰급성뇌경사환자혈청중S100-β함량여발병후뇌경사체적급예후적관계.설계:병례-대조관찰.단위:산동대학산동성립의원신경내과.대상:선택2004-09/2005-08산동성립의원신경내과수치58례결혈성뇌경사환자위병례조,년령36-86세,평균(67.7±14.2)세,남37례,녀21례,균우출현증상24h내입조.납입표준:진단부합제2차전국뇌혈관병학술회의수정적진단표준;전부환자균경두로CT혹자공진등신경계통소묘검사증실부합뇌경사표준.배제표준:유뇌혈관병병사화/혹유류잔질.대조조50례위동기입원건강체검자,남32례,녀18례,년령43～89세,평균(68±9)세,2조간성별급년령구성차이무현저성.방법:①병례조환자재입원당시급제1,2,3,4,6,10천각류취혈액표본1차,대조조수시자부재조신공복시류취혈액표본1차.혈청S100-β수평용ELISA방법측정.②병례조우환자뇌경사발작후제7천경CT급Simes Somatom소제공적연건측량경사체적,신경공능우환자뇌경사발작후3개월평정,평정표준위수정적Rankin등급평분.주요관찰지표:①량조수시자혈청S100-β농도.②병례조환자급성뇌경사발작후제7천시뇌경사체적이급뇌경사발작3개월후신경공능적평정.결과:납입환자58례화정상대조자50례,제병례조중6례환자출현뇌간반사완전소실후2월내사망외,기여균진입결과분석.①병례조환자혈청S100-β단백함량:축점증고,고봉재환자출현급성뇌경사증상후적제3천출현,위(0.61±0.13)μg/L,지제10천하강.경Post-hoc검험,뇌경사6천이내S100-β수평고우대조조,지제10천여대조조비교차이무현저성.②병례조환자혈청S100-β수평:종발병개시적제1,2,3,4,6천(제10천제외)균여최종적뇌경사체적정정상관,재제3천상관성최밀절(r=0.937,P＜0.01).③병례조환자급성뇌경사3개월정황:이개량적Rankin등급평분평정기신경공능회복정황,쌍변량상관분석현시혈청S100-β수평여Rankin등급평분유밀절적정상관성(r=0.507,P＜0.001).결론:혈청중S100-β단백함량여급성뇌경사환자적뇌경사체적정상관,가이보조예측급성뇌경사후신경공능회복상황.
BACKGROUND: Modern neuroradiological imaging techniques such as CT, MRI, and ultrasound help clinicians idenitify the location and volume of an infarct at present. At present, a widely available and easy laboratory examination for acute cerebral infarction is absent.OBJECTIVE: To investigate the relationship between the content S100-β in serum and infarct volume, and prognosis in patients with acute cerebral infarction.DESIGN: Case-control study.SETTING:Department of Neurology of Shandong Provincial Hospital of Shandong University.PARTICIPANTS: From September 2004 to August 2005, 58 patients with acute ischemic brain infarction less than 24 hours after symptom onset were hospitalized in the Department of Neurology of Shandong Provincial Hospital for evaluation and management and enrolled in case group. With the age of 36-86 years and a mean of (68±14) years. 21 were female and 37 were male. Included criteria: The diagnostic criteria was consistent with that of the Second China Cerebrovascular Disease Conference. Every patient who participated in the study underwent the examination of MRI or CT of the brain on admission, the patients were confirmed to be ones with cerebral infarction. Exclusion criteria: A history of a previous stroke and/or existing disability. 50 healthy participants in the control group were from Health Examination Center, including 32 male and 18 female aged 43-89 years and a mean of (68±9) years. Age means and gender were not significantly different between the case group and the control group (P＞0.05).METHODS:① Venous blood samples (2 mL) were drawn in case group at baseline, 1, 2, 3, 4, 6 and 10 days after symptom onset, and the same agent of samples were drawn in control group only at baseline. Enzymelinked immunosorbent assay was used for S100-β measurement. ② Infarct volume of patient was measured by Simes Somatom sensation cardiac wizard workstation volume for CT on day 7 after symptom onset. Neurological outcome was assessed at 3 months after the onset of symptom with modified Rankin scale (MRS) score.MAIN OUTCOME MEASURES: ① Level of S100-β in serum of the subject in the two groups. ② Final infarct volume of patients in case group on day 7 after symptom onset and functional outcome 3 months after symptom onset.RESULTS: 58 patients and 50 healthy control subjects were enrolled in the study. 6 patients in case group developed complete loss of brain stem reflexes and died within 2 months. The others entered the result analysis.①The level of S100-β protein: The level of S100-β protein increased gradually in the case group, peaked at day 3 [(0.61±0.13) μg/L], and decreased at day 10. The levels of S100-β in 6 days after symptom onset were significantly higher than that in control group. The level of S100-β at day 10 in the case group was similar with the control group. ② The level of serum S100-β content in patients of case group: The serum S100-β content were obviously correlated with the infarct volume at 1, 2, 3, 4, 6days after the symptom onset. S100-β value at day 3 provided the highest correlation coefficients (r=0.937, P ＜ 0.001) ③ The status of the cerebral infarction of patients after 3 months: S100-βmeasures and the MRS scores that were obtained 3 months after cerebral infarction revealed highly significant coefficients ranging by bivariate correlations (r=0.507, P ＜ 0.01).CONCLUSION: The content S100-β in serum and infarct volume of the patients with acute cerebral infarction revealed positive correlation. The content S100-β in serum can help to calculate neurological outcome of patients after acute cerebral infarction.