标题：血清炎性因子在颅内血肿清除术前后的变化及其临床意义

      作者：叶富跃，杨 堃，郑传宜，马春阳，王子珍，陈政纲，吴 然
    (海南医学院附属医院神经外科，海南 海口 570102)

      卷次： 2015年26卷20期

      【摘要】 目的 探讨血清新型脂肪酸结合蛋白(h-FABP)、神经元特异烯醇化酶(NSE)、脑组织特异蛋白
S-100B三种炎性因子在颅内血肿清除术前后的变化及其临床意义，为临床决策提供依据。方法 连续纳入于
2012年6月至2014年6月在我院接受颅内血肿清除术的患者120例。按照随访3个月后的ADL评分与手术前评
分的差值(D-value)分为治疗有效组 78例(D-value>20分)和治疗无效组 42例(D-value≤20分)。通过分析两组患
者手术前和手术1周后的血清h-FABP、NSE、S-100B水平，分析手术1周后血清h-FABP、NSE、S-100B水平与手
术疗效、ADL评分的关系，评价血清h-FABP、NSE、S-100B因子对手术疗效、预后的预测作用。结果 手术前和
手术后 1周，有效组患者血清 h-FABP、NSE、S-100B水平明显低于无效组，两组比较差异具有统计学意义(P<
0.05)。手术后1周，有效组上述血清指标较手术前明显降低(P<0.05)，而无效组上述血清指标较手术前无明显变
化(P>0.05)。Logistic回归分析结果显示，手术后1周，三种血清炎性因子水平均与手术疗效有关(P<0.05)。线性
回归分析结果显示，手术后1周，三种血清炎性因子水平均与手术后三个月ADL分数有关(P<0.05)。结论 血清
h-FABP、NSE、S-100B水平在颅内血肿清除术后患者中呈不同程度的降低，且其降低幅度对手术疗效与预后具
有一定的预测作用，并指导治疗方案的制定。

      【关键词】 血清炎性因子；颅内血肿清除术；血清新型脂肪酸结合蛋白；神经元特异烯醇化酶；脑组织特异
蛋白S-100B

      【中图分类号】 R651.1+1 【文献标识码】 A 【文章编号】 1003—6350（2015）20—2988—03


Changes in the levels of serum inflammatory cytokines in patients of intracranial hematoma before and after
surgery and their clinical significance.
YE Fu-yue, YANG Kun, ZHENG Chuan-yi, MA Chun-yang, WANG Zi-zhen,
CHEN Zheng-gang, WU Ran. Department of Neurosurgery, the Affiliated Hospital of Hainan Medical University, Haikou
570102, Hainan, CHINA

【Abstract】 Objective To investigate the changes in the levels of serum fatty acid binding protein (h-FABP),
neuron-specific enolase (NSE), S-100B protein before and after evacuation of intracranial hematoma and their clinical
significance, in order to provide the basis for clinical decision. Methods From June 2012 and June 2014, 120 pa-
tients undergoing evacuation of intracranial hematoma in our hospital were included in our study. According to the dif-
ference between ADL scores before surgery and the scores after 3-year follow-up (D-value), the patients were divided
into effective group (D-value>20, 78 cases) and non-effective group (D-value≤20, 42 cases). By analyzing the levels
of serum h-FABP, NSE, S-100B before surgery and 1 week after surgery, as well as the relationship between serum
h-FABP, NSE, S-100B 1 week after surgery and surgical efficacy, ADL score, the predictive roles of serum h-FABP,
NSE, S-100B in surgical efficacy and prognosis were evaluated. Results Before surgery and 1 week after surgery,
the levels of serum h-FABP, NSE, S-100B of effective group were significantly lower than those of non-effective
group, with statistically significant difference between the two groups (P<0.05). One week after surgery, the serum in-
dexes of effective group were significantly lower than those before surgery (P<0.05), while the serum indexes of
non-effective group showed no statistically significant difference compared with those before surgery (P>0.05). Logis-
tic regression analysis showed that the three serum inflammatory cytokines indexes 1 week after surgery were all corre-
lated to surgical efficacy (P<0.05). Linear regression analysis results showed that the levels of the three indexes 1 week
after surgery were correlated to 3-year post-operative ADL score (P<0.05). Conclusion The levels of serum h-FABP,
NSE, S-100B have different degrees of reduction after evacuation of intracranial hematoma, and the reduction degrees
have a certain predictive role in surgical efficacy and prognosis, and the formulation of treatment programs.

      【Key words】 Serum inflammatory cytokines; Evacuation of intracranial hematoma; Serum fatty acid binding
protein (h-FABP); Neuron-specific enolase (NSE); S-100B protein
基金项目：国家自然科学基金(编号：8126037)；海南医学院人才启动基金(编号：2012005)