重型颅脑损伤患者血清 NSE 和 MMPs 的动态变化及临床意义

目的：探讨重型颅脑损伤患者早期神经元特异性烯醇化酶和基质金属蛋白酶类的动态变化情况及其与疾病严重程度、疾病进展与相关预后的关系，为重型颅脑损伤的诊治提供依据。方法：随机选取2014年1月～2015年10月我院神经外科收治的重型颅脑损伤患者40例，作为观察组的研究对象，并选取同期40例健康体检者作为对照组的研究对象。记录两组外周血神经元特异性烯醇化酶、基质金属蛋白酶-9和基质金属蛋白酶-2在入院后不同时间点的动态变化，并对不同时间点各指标与格拉斯哥（GCS）得分的相关性分析和通过 ROC 曲线比较两种指标的实验室数据曲线下面积、灵敏度等指标，以判断对重型颅脑损伤疾病有较好识别能力的指标体系。结果：观察组患者 NSE 水平明显高于对照组，在3d 有降低，之后出现升高，在第5d 达到高值；MMP-9和 MMP-2水平均先在3d 有降低，而后在第5d 出现峰值。根据 GCS 得分与患者的 NSE、MMP-9、MMP-2的含量进行相关性分析显示，各组 Person 相关系数 r 均为负相关。NSE、MMPs 两个指标进行组合和单个因素的 ROC 曲线分析，显示NSE-MMPs 组合指标在 ROC 的 AUC 最大，为0.85，其灵敏度为91%，特异度为83.5%。结论：重症颅脑损伤患者的 NSE、MMP-9、MMP-2在1d、3d、5d 和7d 变化趋势与疾病进展规律接近。NSE、MMPs 水平与 GCS 得分呈负相关，证实 NSE-MMPs 能间接反映重症颅脑损伤的严重程度，且能为该病治疗预后的判断提供支持。

Dynamic changes of serum NSE and MMPs in patients with severe craniocerebral injury and its clinical significance

Objective To explore severe brain damage the patients with early neuron specific enolase(NSE)and matrix met-alloproteinases, the dynamic change and its relationship with the severity of disease, disease progression and prognosis, so as to provide the evidence for the diagnosis and treatment of severe craniocerebral injury. Methods Randomly selected from January 2015 2014 and October in our hospital were selected from the Department of neurosurgery in patients with severe craniocer-ebral injury in 40 cases, as the object of study in the observation group, and select the same period 40 cases of healthy person as the object of study in the control group. Record the two groups of peripheral blood neuron specific enolase(NSE), matrix metal-loproteinase 9(MMP-9)and matrix metal proteinase 2 after admission in dynamic changes at different time points and the cor-relation of different time points of the index and the Glasgow score(GCS)analysis and by ROC curve comparison of two indica-tors of laboratory data curve area and sensitivity index to judge of severe craniocerebral injury diseases have better recognition ability of the index system. Results The NSE level in patients group was significantly higher than that of the control group, in 3D and decreased after increased, reaching the high value in the 5D; MMP-2 and MMP-9 levels were first in the 3D decreased, and then at the 5th day peak. According to the content of GCS score and the patient of neuron specific enolase(NSE), MMP-9, MMP-2 revealed by correlation analysis and groups to the Pearson correlation coefficient r were negatively correlated. The ROC curve of combination and the single factor analysis of neuron specific enolase(NSE), MMPs two indicators, showing NSE-MMPs combination index was maximum in the AUC of ROC, 0.85, the sensitivity was 91%, specificity was 83.5%. Conclusion In pa-tients with severe head injury NSE, MMP-9, 1D, 3D, MMP-2 in 5D and 7d change tendency and the rule of disease to progress. An inverse NSE, MMPs level and GCS score was negatively correlated with that NSE-MMPs can indirectly reflect the severity of severe craniocerebral injury, and provides support for the disease treatment and prognosis judgment.