急性高血压脑出血患者血浆CXCL12水平与脑水肿的相关性研究

Correlation between plasma CXCL12 level and brain edema in patients with acute hypertensive intracerebral hemorrhage

摘要:

目的 探讨急性高血压脑出血患者血浆CXCL12水平的动态变化及其对预后的影响，以及血浆CXCL12水平与相对水肿体积的关系。方法 选择急性高血压脑出血患者34例，于发病24小时内、第3天、第7天和第14天采用ELISA法检测血浆CXCL12水平，选择同期25例健康体检者作为对照组。根据mRS评分将脑出血患者分为预后良好组（mRS≤2分）和预后不良组（mRS>2分）。于发病24小时内、第3天和第7天根据颅脑CT计算相对水肿体积。结果 脑出血组24小时内血浆CXCL12水平（19.85±1.84）μg/L明显高于对照组（11.34±2.23）μg/L，P<0.01。脑出血组血浆CXCL12水平在第3天时快速上升（22.56±1.56）μg/L，在第7天达高峰（23.38±1.53）μg/L，在第14天时下降（22.64±1.78）μg/L。预后良好组与整体的变化趋势一致，预后不良组血浆CXCL12水平在第14天时未见下降；两组血浆CXCL12水平在第7天时和第14天时比较差异均有统计学意义，P值分别为<0.05和<0.01。Pearson相关性分析显示第3天和第7天血浆CXCL12水平与相对水肿体积呈正相关，相关系数分别为（r=0.631，P<0.01）和（r=0.435，P<0.05）。结论 血浆CXCL12水平在脑出血后明显升高，持续性CXCL12水平升高的患者预后较差。动态检测血浆CXCL12水平能够为脑水肿的评估和治疗提供依据。

Abstract:

Objective To investigate the dynamic changes in plasma CXCL12 level and their influence on prognosis in patients with acute hypertensive intracerebral hemorrhage (AHIH), as well as the correlation between plasma CXCL12 level and relative edema volume.Methods A total of 34 patients with AHIH were enrolled and ELISA was used to measure plasma CXCL12 level within 24 hours and at 3, 7, and 14 days after onset. A total of 25 healthy subjects who underwent physical examination were enrolled as control group. According to modified Rankin Scale (mRS) score, the patients with AHIH were divided into good outcome group (mRS≤2) and poor outcome group (mRS>2). Relative edema volume was calculated based on cranial CT results within 24 hours and at 3 and 7 days after onset.Results The AHIH group had a significantly higher plasma CXCL12 level within 24 hours than the control group (19.85±1.84 μg/L vs 11.34±2.23 μg/L, P<0.01). The AHIH group had a rapid increase in plasma CXCL12 level at 3 days after onset (22.56±1.56 μg/L), a peak plasma CXCL12 level at 7 days after onset (23.38±1.53 μg/L), and a reduction in plasma CXCL12 level at 14 days after onset (22.64±1.78 μg/L). The good outcome group followed this trend, while the poor outcome group had no reduction in plasma CXCL12 level at 14 days. There were significant differences in plasma CXCL12 level at 7 and 14 days between the two groups (P<0.05 and P<0.01). Pearson correlation analysis showed that at 3 and 7 days, plasma CXCL12 level was positively correlated with relative edema volume (r=0.631, P<0.01; r=0.435, P<0.05).Conclusions There is a significant increase in plasma CXCL12 level after intracerebral hemorrhage, and patients with a continuous increase in plasma CXCL12 level tend to have poor prognosis. Dynamic monitoring of plasma CXCL12 level can provide a basis for the assessment and treatment of cerebral edema.