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目的前瞻性动态观察脑内出血患者血肿体积的变化与外周血中分子生物标志的相关性,筛选出早期血肿扩大的预警指标,为探索脑内出血早期血肿扩大的可能机制提供理论依据。方法本研究是一项前瞻性队列研究,连续收集发病6h内的自发性脑出血患者共67例,符合条件者54例,搜集临床资料及血标本,血标本采用酶联接免疫吸附剂测定法检测细胞纤维连接蛋白、基质金属蛋白酶-9、金属蛋白酶抑制因子-1并收集常规实验室指标如纤维蛋白原等,依据血肿扩大标准进行分组分析及早期血肿扩大的多因素分析。结果 67例患者中,发病24h共54人复查颅脑CT,16例出现血肿扩大,血肿扩大的发生率为29.63%,早期血肿扩大患者与血肿未扩大患者在纤维蛋白原水平方面差异具有统计学意义(2.3±0.7 vs 2.9±0.7g/L,P=0.008),血肿扩大患者与血肿未扩大患者不规则血肿形态发生率方面差异具有统计学意义(50.0%vs 13.2%,P=0.011),相关因素分析显示基质金属蛋白酶-9、纤维蛋白原与脑内出血早期血肿扩大的相关性有统计学意义(OR=12.093,P=0.032;OR=0.162,P=0.041)。结论纤维蛋白原、基质金属蛋白酶-9与脑内出血早期血肿扩大具有相关性,细胞纤维连接蛋白和金属蛋白酶抑制因子-1未发现明显的相关性。
Objective To prospectively observe the relationship between changes of hematoma volume and molecular biomarkers in peripheral blood in patients with intracerebral hemorrhage and to screen out the early warning index of early hematoma enlargement and provide a theoretical basis for exploring the possible mechanism of early hematoma enlargement in intracerebral hemorrhage. Methods This study was a prospective cohort study. Sixty-seven consecutive patients with spontaneous intracerebral hemorrhage within 6 hours after onset were enrolled in this study. Fifty-four eligible patients were collected. Clinical data and blood samples were collected. Blood samples were detected by enzyme-linked immunosorbent assay Cell Fibronectin, Matrix Metalloproteinase-9, and Metalloproteinase Inhibitor-1 were collected and routine laboratory markers such as fibrinogen were collected. Group analysis according to hematoma enlargement criteria and multivariate analysis of early hematoma enlargement were performed. Results Of the 67 patients, 54 were rechecked in brain CT at 24 hours after onset. The hematoma enlarged and the hematoma enlarged in 16 cases. The incidence of hematoma enlargement was 29.63%. There were statistically significant differences in fibrinogen between patients with early hematoma enlargement and those without hematoma expansion (50.0% vs 13.2%, P = 0.011) in patients with hematoma enlargement and those with non-enlarged hematoma (2.3 ± 0.7 vs 2.9 ± 0.7g / L, P = 0.008) Correlation analysis showed that the correlation between MMP-9, fibrinogen and early hematoma enlargement in intracerebral hemorrhage was statistically significant (OR = 12.093, P = 0.032; OR = 0.162, P = 0.041). Conclusion Fibrinogen, matrix metalloproteinase-9 is associated with the enlargement of hematoma in early stage of intracerebral hemorrhage. There is no obvious correlation between fibronectin and metalloproteinase-1.