【作者】 黄志纯；

【导师】 田新华；

【作者基本信息】 福建医科大学 ， 外科学， 2011， 硕士

【摘要】 【目的】:通过监测急性重型颅脑损伤患者急性期血清中神经元特异性烯醇化酶(NSE)、基质金属蛋白酶-2(MMP-2)和基质金属蛋白酶-9(MMP-9)水平的动态变化规律,探讨其与病情演变、治疗预后的相关性临床意义。【方法】:采用前瞻性对比研究方法收集重型颅脑损伤患者共86例及对照组20例。采用ELISA法检测血清中NSE、MMP-2及MMP-9水平,分析其变化趋势,结合GOS评分及预后情况进行分析比较。【结果】:总体监测重型颅脑损伤后患者血清NSE、MMP-2及MMP-9蛋白浓度在各时间点显著高于对照组(P<0.01)。其中NSE浓度高峰出现在第5天,此后至第7天仍处于较高水平,NSE浓度趋势与GCS评分变化呈负相关,相关系数r=﹣0.117。MMP-2、MMP-9浓度在外伤后的第1天即出现升高,第1次高峰出现在第3天,第2次高峰出现第5天,第7天有所下降,但仍显著高于对照组。GCS3-5分与GCS6-8分组对照中,MMP-2浓度值在各监测点(均前组大于后组),P<0.01,组间差异有显著性差异。NSE及MMP-9中,P>0.01,差异没有统计学意义,提示MMP-2在早期评估颅脑损伤程度的价值优于NES及MMP-9。预后不良组患者伤后第1、3、5、7天血清MMP-2、MMP-9浓度显著高于相同时间点的预后良好组患者(P<0.01),NSE在两组对照中差异也有统计学意义。根据ROC曲线结果:MMP-9检测的在预后评估中价值最高,其次为MMP-2,而NSE预测价值最差。【结论】:血清NSE、MMP-2、MMP-9蛋白测定对于早期评估重型颅脑损伤的严重程度有重要意义,可以提示颅脑外伤患者病情变化,为临床颅脑损伤患者的诊治提供新的指标,且可作为预后评估重要检测手段。更多还原

【Abstract】 Objective:To investigate the changes in the serunm levels of neuron specific enolase and matrix metalloproteinases-2 and matrix metalloproteinases-9 and their clinical indications in the patients after severe traumatic brain injury.Method:A prospective control study was carried out.The serunm from 56 sTBI patients and 20 normal persons were collected to measure the levels of NSE、MMP-2 and MMP-9 by using ELISA and analyzed the change trend of them together with Glasgow Outcome Scale.Result:The serum levels of NSE、MMP-2 and MMP-9 were significantly higher in the brain trauma group than those in the control group(P<0.01). The serum levels of NSE peaked on 5th day,although dropping on the 7th day after brain trauma ,was significantly higher in the brain trauma group than that in the control group. The serum levels of MMP-2、MMP-9 peaked on 1st day and the second peak appeared on 5th day and than dropping on 7th day. The serum levels of NSE、MMP-2 and MMP-9 were significantly higher in the patients with poor prognoses group than those with good prognoses group(P<0.01).Conclusion:NSE、MMP-2 and MMP-9 of the serum were involved in the pathological process of acute brain injury, and might play an important role in secondary brain injury .Determination of their contents was of clinical importance for evaluation of the severity of injury and outcome prediction.更多还原