自发性脑出血患者血清降钙素原、淀粉样蛋白A及和肽素动态检测

摘要

Aim:To investigate the dynamic changes of serum procalcitonin(PCT),serum amyloid A(SAA),and ser-um copeptin(CPP) in patients with different degrees of intracerebral hemorrhage(ICH) and their relationship with clinical prognosis.Methods:A total of 127 patients with ICH were divided into three groups according to Hemphill index:49 cases were mild(2 points),48 cases were moderate(2 points),30 cases were severe (≥3 points). The 3 indexes were deter-mined on the 2nd,3rd day,and 1 week,2 weeks and 3 weeks after onset. At the same time,the patients were divided into good prognosis group and poor prognosis group according to the change of NIHSS score on the 3rd week after admission,then the differences of serum PCT,SAA and CPP between the two groups were compared.Results:The values of PCT,SAA and CPP increased with the severity of ICH(P<0.001). After onset,the values of PCT,SAA and CPP in each group nearly all increased gradually with time,and then tended to fall back after the peak(P<0.001). PCT and CPP peaked on the 3rd day and SAA peaked on the 2nd day in the mild group;PCT and CPP peaked at 1 week after onset and SAA peaked at 2 weeks in the moderate group;PCT and CPP peaked at 2 weeks and SAA peaked at 3 weeks in the severe group.The three indicators showed that the more severe the condition was,the later the peak time reached. After 3 weeks of treatment,whether infected or not,the values of PCT,CPP and SAA were lower in ICH patients from good prognosis group than those from poor prognosis group(P<0.05).Conclusion:Serum PCT,SAA and CPP can reflect the severity of ICH patients,which can be used as in-dexes to predict ICH prognosis.%目的:了解不同程度病情的自发性脑出血患者血清降钙素原(PCT)、淀粉样蛋白 A(SAA)、和肽素(CPP)的动态变化及其与临床预后的关系.方法:127例自发性脑出血患者按照入院时Hemphill脑出血评分标准分为轻型( <2分)49例、中型(2分)48例、重型(≥3分)30例,并于发病第2天、第3天、1周、2周、3周时分别测定血清PCT、SAA和CPP水平,同时根据入院时及入院第3周NIHSS评分的变化将患者分为预后良好组与预后不良组,比较预后良好组与预后不良组患者血清PCT、SAA和CPP水平的差异.结果:血清PCT、SAA和CPP水平均随病情的加重呈升高的趋势(P均<0.001).发病后轻型、中型和重型组PCT、SAA和CPP水平随时间的延长多呈先逐渐升高,到达峰值后又趋于回降的趋势(P均<0.001).轻型组发病后第3天PCT和CPP达峰值,SAA发病后第2天达峰值;中型组发病后1周PCT和CPP达峰值,SAA 2周达峰值;重型组发病后2周PCT和CPP达峰值, SAA 3周达峰值.3项指标均呈现病情越重达峰值时间越晚的趋势.治疗3周后,无论是否发生感染,自发性脑出血患者预后良好组血清PCT、CPP、SAA水平均低于预后不良组(P均<0.05).结论:血清PCT、SAA和CPP均可反映自发性脑出血患者的病情严重程度,可作为预测自发性脑出血预后的指标.