出血性脑卒中临床预后因素的分析

目的探讨转化生长因子β1(TGF-β1)、神经元特异性烯醇化酶(NSE)等对出血性脑卒中后脑损伤和临床预后的影响。方法检测103例急性出血性脑卒中患者(出血性脑卒中组)血清TGF-β1、NSE水平并与68例健康体检者(健康对照组)比较,以3个月Barthel指数评分为临床预后指标,各因素进行单因素与多元回归分析。结果出血性脑卒中组患者急性期血清TGF-β1低于健康对照组(P<0.01)。NSE高于健康对照组(P<0.01)。单因素分析,TGF-β1、住院天数为出血性脑卒中患者神经功能恢复好的因素。NSE高、意识障碍程度重、出血量大、入院神经功能缺损评分高、空腹血糖高、外周血白细胞计数高、发热、最高体温高、患者年龄大、合并感染者神经功能恢复差。多元回归分析,血清TGF-β1、NSE、出血量、意识障碍程度、入院神经功能缺损评分影响出血性脑卒中患者临床预后。结论出血性脑卒中患者急性期血清TGF-β1明显下降;重症患者NSE显著增高。

Analysis of factors affecting the clinical outcome of hemorrhagic stroke

Objective To explore the effects of TGF-β1,neuron-specific enolase(NSE),etc.on the clinical outcome of hemorrhagic stroke.Methods The levels of TGF-β1 and NSE in serum during acute period(72 hours after attack) of 103 patients with acute hemorrhagic stroke were measured and compared with those of the healthy controls(68 persons).The relation between every observing factor and clinical outcome of hemorrhagic stroke(Barthel index at 3 months) was analyzed using univariate and multivariate analyses.Results The serum level of TGF-β1 ! during acute period of 103 patients with acute hemorrhagic stroke was lower than that of the healthy controls(P<0.01) and the serum level of NSE during acute period of these patients was higher than that of the healthy controls(P<0.01).TGF-β1 and days of hospital stay showed active effect on the clinical outcome in linear regression analysis.High NSE,severe disturbance of consciousness,big hematoma volume,high clinical neurological deficits on admission,high fasting serum glucose,high leucocyte count in peripheral blood,fever,high body temperature,old age and complication with infection made the clinical outcome poor.Serum TGF-β1,NSE,hematoma volume,disturbance of consciousness and clinical neurological deficits might affect the clinical outcome of hemorrhagic stroke in multivariate regression analysis.Conclusion The serum level of TGF-β1 during acute period of patients with acute hemorrhagic stroke decreased significantly and NSE increased significantly in severe patients.