CAJ | 학술논문

目的观察高血压脑出血患者行颅内血肿微创清除术前后血清心脏型脂肪酸结合蛋白（h-FABP）、神经元特异性烯醇化酶（NSE）、S-100蛋白B（S-100B）水平变化及临床疗效，探讨血清h-FABP、NSE、S-100B水平变化与病情及预后的关系。方法采用酶联免疫吸附法（ELISA）检测119例高血压脑出血患者（手术组74例和保守组45例）血清h-FABP、NSE、S-100B水平，并进行临床疗效对比分析。结果（1）高血压脑出血患者血清h-FABP 、NSE和S-100B水平均显著高于对照组，差异有统计学意义（P＜0．01）；出血量小于60 mL和生存组患者血清 h-FABP 、NSE和S-100B水平均分别显著低于出血量大于60 mL和死亡组患者（P＜0．01）。（2）h-FABP与NSE、S-100B呈正相关性（r＝0．513、0．747，P＜0．01），NSE与S-100B也呈正相关性（r＝0．492，P＜0．01），三者之间相关性良好。（3）高血压脑出血术后死亡组术后1～7 d血清h-FABP 、NSE和S-100B水平均显著高于对照组，差异有统计学意义（P＜0．01）；高血压脑出血术后生存组术后第5天血清h-FABP 、NSE和S-100B水平均达正常。（4）手术组无效率和病死率显著降低（P＜0．01），有效率显著提高（P＜0．01）；出血量小于60 mL组有效率显著高于大于60 mL组（P＜0．01）。结论颅内血肿微创清除术治疗高血压脑出血临床疗效显著优于内科保守治疗，检测高血压脑出血患者微创术前后血清h-FABP 、NSE和S-100B水平变化，可作为判断疾病严重程度、评价手术疗效和估计预后的重要参数。
목적관찰고혈압뇌출혈환자행로내혈종미창청제술전후혈청심장형지방산결합단백（h-FABP）、신경원특이성희순화매（NSE）、S-100단백B（S-100B）수평변화급림상료효，탐토혈청h-FABP、NSE、S-100B수평변화여병정급예후적관계。방법채용매련면역흡부법（ELISA）검측119례고혈압뇌출혈환자（수술조74례화보수조45례）혈청h-FABP、NSE、S-100B수평，병진행림상료효대비분석。결과（1）고혈압뇌출혈환자혈청h-FABP 、NSE화S-100B수평균현저고우대조조，차이유통계학의의（P＜0．01）；출혈량소우60 mL화생존조환자혈청 h-FABP 、NSE화S-100B수평균분별현저저우출혈량대우60 mL화사망조환자（P＜0．01）。（2）h-FABP여NSE、S-100B정정상관성（r＝0．513、0．747，P＜0．01），NSE여S-100B야정정상관성（r＝0．492，P＜0．01），삼자지간상관성량호。（3）고혈압뇌출혈술후사망조술후1～7 d혈청h-FABP 、NSE화S-100B수평균현저고우대조조，차이유통계학의의（P＜0．01）；고혈압뇌출혈술후생존조술후제5천혈청h-FABP 、NSE화S-100B수평균체정상。（4）수술조무효솔화병사솔현저강저（P＜0．01），유효솔현저제고（P＜0．01）；출혈량소우60 mL조유효솔현저고우대우60 mL조（P＜0．01）。결론로내혈종미창청제술치료고혈압뇌출혈림상료효현저우우내과보수치료，검측고혈압뇌출혈환자미창술전후혈청h-FABP 、NSE화S-100B수평변화，가작위판단질병엄중정도、평개수술료효화고계예후적중요삼수。
Objective To investigate application significance of the detection of serum heart type fatty acid binding proteins (h-FABP) ,neuronspecific enolase (NSE) and S-100 protein B (S-100B) in patients with hyperten-sive cerebral hemorrhagc (HCH) ,and to analyze therapeutic effect .Methods Serum h-FABP ,NSE and S-100B lev-els were detected in 74 HCH patients receiving minimally invasive intracranial hematoma (IH ) dissection surgery (operation group) and 45 HCH patients receiving conservative therapy (conservation group) by using enzyme linked immunosorbent assay ,and the therapeutic effect was compared .Results Serum levels of h-FABP ,NSE and S-100B were significantly higher than control group (P<0 .01) ,and those in patients with bleeding less than 60 mL and sur-vival group were significantly lower than patients with bleeding more than 60 mL and death group (P<0 .01) .h-FABP level was positively correlated with NSE and S-100B (r=0 .513 ,0 .747 ,P<0 .01) ,and NSE was also posi-tively correlated with S-100B (r=0 .492 ,P<0 .01) .h-FABP ,NSE and S-100B levels detected 1-7 days after surger-y ,in patients ,who died after surgery ,were significantly higher than control group (P<0 .01) ,and those detected on the fifth day after surgery in patients ,who survived after surgery ,reached normal levels .Invalid and mortality rates were significantly reduced in operation group (P<0 .01) ,and efficient rate increased significantly (P<0 .01) . Efficient rage in patients with bleeding less than 60 mL was significantly higher than patients with bleeding more than 60 mL (P<0 .01) .Conclusion Minimally invasive IH dissection surgery might be more effective than conserva-tive therapy for treatment of HCH .Monitoring of serum h-FABP ,NSE and S-100B levels could be helpful for the judgment of disease severity ,evaluation of therapeutic effect and estimation of prognosis .