胸腹主动脉瘤手术患者血脑屏障损伤生化标志物的监测与评估

摘要

目的:探讨胸腹主动脉瘤手术患者的血脑屏障损伤,评价血清和脑脊液S100B蛋白、神经元特异性烯醇化酶(NSE)和胶质原纤维酸性蛋白(GFAP)诊断血脑屏障损伤的价值.方法:检测和分析15例胸腹主动脉置换患者,男性11例,女性4例,平均年龄46岁.围手术期各时间点白蛋白商值和脑脊液-IgG指数,并以其为标准评估血脑屏障损伤、以及其与血清和脑脊液的S100B、GFAP和NSE蛋白的相关性.结果:12例在主动脉重新开放后2 h至12 h时间内,白蛋白商值升高至9～28,而脑脊液-IgG 指数升高至0.8～2,有3例患者血脑屏障损伤重:2例白蛋白分别升高至38.6和41.8,1例脑脊液-IgG 指数升高至3.06.结论:胸腹主动脉手术中白蛋白商值和脑脊液-IgG指数会出现-过性轻到中度升高,提示血脑屏障-过性轻中度损害可能,未发现白蛋白商值和脑脊液-IgG指数与S100B、GFAP及NSE具有相关性.%Objective :To study the effect of lower serum albumin level ( before and after operation) to clinical outcome in the patient with heart valve surgery. Methods : A cross sectional study was carried out in 154 patients being hospitalized with heart valve operation between Octoher 2010 and January 2011. The serum albumin (ALB) was examined at admission and once a week after operation. The last ALB hefore patient leaving hospital was defined as after operation ALB level. The clinical outcome was compared between lower ALB group ( ALB ＜35 g/L) and normal ALB group (ALB≥35 g/L). The clinical outcome include hospital stays postoperative, time of stay in the intensive care units (ICU), infection or not, reopevation or not, If adverse prognosis or not and hospitalization expense. Results : Compared between ALB≥35 g/L group with ALB ＜ 35 g/Lgroup at admission, there were not difference in clinical outcome. The ALB level after operation had close relations with clinical outcome. ALB ＜ 35 g/Lgroup was significantly longer in hospital stays after operation and length of stay in ICU than ALB≥35 g/L group ( P ＜ 0.01), In addition, the incidence of adverse prognosis and rate of infection were higher than ALB≥35 g/L group. The rate of second operation and hospitalization expense were not statistical different. To remove lower ALB cases before operation, this tendency was also evident. The correlation analysis showed that the level ALB at admission was negative related to the hospiLal stays after operation ( r = -0.124 , P = 0.038 ) ; and the level of ALB after operation were negative related to the hospital atays after operation and length of stay in lCU ( r=-0.544,P=0.000 and r=-0.198 , P = 0.001 ) .Conclusion: Lower ALB level after operation is important factor to outcome for patient with heart valve operation.