脑出血急性期血清神经递质及应激激素变化与继发性脑损伤的关系

doi:10.3969/j.issn.1006-5725.2024.23.010

Abstract

Abstract:

Objective To investigate the relationship between the changes of serum neurotransmitters and stress hormones and secondary brain injury （SBI） in acute stage of cerebral hemorrhage. Methods The data of 149 patients with intracerebral hemorrhage admitted to the hospital from January 2020 to December 2023 were retrospectively analyzed. The patients with intracerebral hemorrhage who developed SBI 5 days after treatment were divided into the group with SBI and the group without SBI. Serum neurotransmitters and stress hormones were measured before treatment and 3 days after treatment. The levels of serum neurotransmitters and stress hormones in patients with and without SBI were compared， the factors affecting the occurrence of SBI were analyzed， and the value of serum neurotransmitters and stress hormones in predicting the occurrence of SBI in patients with cerebral hemorrhage was analyzed. Results Logistic regression analysis showed acute physiological and chronic health status score Ⅱ， cerebral hemorrhage volume， gamma-aminobutyric acid （GABA） level and adrenocorticotropin releasing hormone （CRH） were the factors affecting the complication of SBI in patients with cerebral hemorrhage （P < 0.05）. ROC curve analysis results showed that the sensitivity of GABA， CRH and their combined prediction of SBI in patients with cerebral hemorrhage were 68.29%， 70.73% and 85.37%， the specificity was 70.37%， 72.22% and 89.81%， and the AUC was 0.708 （95%CI： 0.604 ~ 0.813）， 0.711 （95%CI： 0.597 ~ 0.825）， 0.882 （95%CI： 0.812 ~ 0.951）. Conclusion Serum neurotransmitter GABA and stress hormone CRH are related to the complication of SBI in patients with cerebral hemorrhage， and the combination of GABA and CRH is effective in predicting the complication of SBI in patients with cerebral hemorrhage.

Key words: cerebral hemorrhage, neurotransmitter, stress hormone, secondary brain injury

CLC Number:

Han XU,Yue LU,Pu. YUAN. Relationship between changes of serum neurotransmitters and stress hormones and secondary brain injury during acute cerebral hemorrhage[J]. The Journal of Practical Medicine, 2024, 40(23): 3343-3348.

Figures/Tables 5

Tab.1

Tab.2

Tab.3

Analysis of factors affecting cerebral hemorrhage complicated with SBI"

因素	b	Sb	Wald $χ 2$	OR值	95%CI
APACHE Ⅱ评分	1.601	0.324	24.417	4.958	2.040 ~ 12.050
脑出血量	1.523	0.271	31.584	4.586	1.887 ~ 11.145
GABA	1.321	0.403	10.745	3.747	1.542 ~ 9.107
CRH	1.304	0.362	12.976	3.684	1.516 ~ 8.953

Tab.3

Tab.4

Fig.1

References 25

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因素	并发SBI组（n = 41）	未并发SBI组（n = 108）	t/χ² 值	P值
性别/［例（%）］			1.534	0.215
男	27（65.85）	59（54.63）
女	14（34.15）	49（45.37）
年龄≥ 60岁/［例（%）］	28（68.29）	58（53.70）	2.592	0.107
体质量指数≥25 kg/m²/［例（%）］	7（17.07）	13（12.04）	0.649	0.421
基础疾病/［例（%）］
高血压	40（97.56）	98（90.74）	2.022	0.155
糖尿病	30（73.17）	74（68.52）	0.305	0.581
高脂血症	26（63.41）	56（51.85）	1.606	0.205
冠心病	8（19.51）	14（12.96）	1.013	0.314
吸烟史/［例（%）］	21（51.22）	43（39.81）	1.577	0.209
饮酒史/［例（%）］	14（34.15）	25（23.15）	1.860	0.173
卒中病史/［例（%）］	7（17.07）	12（11.11）	0.949	0.330
APACHE Ⅱ评分/分	32.14 ± 4.26	30.01 ± 3.74	2.986	0.003
GCS评分/分	9.85 ± 1.47	11.23 ± 1.59	4.828	0.000
左心室射血分数/%	47.96 ± 5.21	48.92 ± 4.95	1.042	0.299
发病至入院时间/h	8.05 ± 1.46	8.46 ± 1.53	1.479	0.141
出血部位/［例（%）］			0.880	0.644
基底节区	16（39.02）	50（46.30）
丘脑	15（36.59）	38（35.19）
脑叶	10（24.39）	20（18.52）
脑出血量/mL	37.65 ± 4.82	34.26 ± 3.94	4.402	0.000
破入脑室/［例（%）］	12（29.27）	20（18.52）	2.036	0.154
合并脑疝/［例（%）］	5（12.20）	8（7.41）	0.855	0.355
颅内压/mmHg	18.95 ± 3.41	16.13 ± 2.82	5.138	0.000
手术情况/［例（%）］			1.442	0.486
未手术	26（63.41）	70（64.81）
开颅手术	4（9.76）	5（4.63）
微创手术	11（26.83）	33（30.56）
白细胞计数/（×10⁹/L）	59.36 ± 8.12	57.94 ± 7.93	0.970	0.334
血小板计数/（×10⁹/L）	187.69 ± 21.41	184.32 ± 20.84	0.875	0.383
PT/s	13.24 ± 1.86	12.86 ± 1.79	1.145	0.254
TT/s	13.08 ± 1.69	12.69 ± 1.61	1.303	0.195

因素	并发SBI组（n = 41）	未并发SBI组（n = 108）	t值	P值
治疗前	5.21 ± 0.85	5.42 ± 0.91	1.280	0.202
GABA/（μmol/L）
Glu/（μmol/L）	89.62 ± 10.41	87.01 ± 9.98	1.409	0.161
Asp/（U/L）	60.03 ± 9.25	57.92 ± 9.03	1.265	0.208
Gly/（μmol/L）	402.31 ± 42.15	390.51 ± 38.36	1.632	0.105
NPY/（μg/L）	210.36 ± 35.94	203.31 ± 32.01	1.160	0.248
NTF/（ng/mL）	2.98 ± 0.32	3.06 ± 0.35	1.275	0.204
NSE/（μg/L）	28.65 ± 3.14	29.56 ± 2.97	1.644	0.102
NGF/（pg/mL）	45.32 ± 4.96	43.96 ± 4.25	1.664	0.098
CRH/（pmol/L）	24.16 ± 3.51	23.21 ± 3.36	1.523	0.130
AD/（ng/mL）	0.26 ± 0.29	0.33 ± 0.31	1.252	0.212
Cor/（nmol/L）	189.68 ± 20.04	194.36 ± 19.85	1.282	0.202
AVP/（ng/L）	5.21 ± 0.82	5.46 ± 0.85	1.619	0.108
NE/（ng/L）	385.24 ± 51.05	370.39 ± 48.24	1.651	0.101
治疗3 d	7.26 ± 1.01	8.96 ± 1.15	8.322	0.000
GABA/（μmol/L）
Glu/（μmol/L）	72.31 ± 8.21	70.12 ± 7.96	1.487	0.139
Asp/（U/L）	40.03 ± 5.14	32.15 ± 3.98	9.929	0.000
Gly/（μmol/L）	282.51 ± 42.16	269.85 ± 40.31	1.691	0.093
NPY/（μg/L）	156.32 ± 26.41	121.19 ± 20.03	8.725	0.000
NTF/（ng/mL）	4.23 ± 0.71	4.42 ± 0.75	1.401	0.163
NSE/（μg/L）	16.98 ± 2.14	12.84 ± 1.96	11.225	0.000
NGF/（pg/mL）	65.94 ± 10.23	68.72 ± 8.97	1.624	0.106
CRH/（pmol/L）	10.98 ± 2.01	7.21 ± 1.26	13.686	0.000
AD/（ng/mL）	0.48 ± 0.09	0.51 ± 0.10	1.679	0.095
Cor/（nmol/L）	128.96 ± 20.14	105.13 ± 17.23	7.190	0.000
AVP/（ng/L）	2.41 ± 0.42	2.29 ± 0.41	1.585	0.115
NE/（ng/L）	264.01 ± 29.84	249.89 ± 27.61	2.726	0.007

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Relationship between changes of serum neurotransmitters and stress hormones and secondary brain injury during acute cerebral hemorrhage

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指标	最佳截断值	灵敏度/%	特异度/%	AUC	95%CI
GABA	8.12 μmol /L	68.29	70.37	0.708	0.604 ~ 0.813
CRH	9.01 pmol /L	70.73	72.22	0.711	0.597 ~ 0.825
联合	—	85.37	89.81	0.882	0.812 ~ 0.951