Oh Seung Hun, Lee Jin Goo, Na Sang Jun, Park Ji Hyung, Kim Won Joo
Department of Neurology, Yongdong Severance Hospital, P.O. Box 1217, Seoul 135-720, Korea.
Yonsei Med J. 2002 Jun;43(3):357-62. doi: 10.3349/ymj.2002.43.3.357.
The prediction of functional outcome in patients with acute cerebral infarction depends on many factors. Various techniques have been applied to predict severity and outcome after cerebral infarction. Neuron-specific enolase (NSE) is a component of a specific brain enzyme and a useful marker of brain injury. We evaluated the relation between initial serum NSE level and short- and long-term clinical outcome in 59 patients with acute cerebral infarction and in 38 age-matched healthy controls. Serum NSE levels were determined in patients with carotid artery (CA) territory cerebral infarction within 24 hours of onset. Brain MRI was performed four to seven days after stroke. Patients were divided into two groups: large CA territory infarction with a lesion extending cortex (cortex group), and small subcortical CA territory infarction (subcortical group) with a lesion confined to the subcortical white matter. We compared the initial serum NSE levels of the two groups. National Institute of Health Stroke Scale (NIHSS) was determined at admission and seven days after onset and the modified Rankin's scale was used at the 3 months follow-up after onset. Serum NSE levels were significantly elevated in patients with acute cerebral infarction compared with the normal controls (13.88 +/- 5.47 ng/dl vs. 8.15 +/- 1.53 ng/dl, p < 0.05). The initial (< 24 h) serum NSE level was higher in the cortical group than in the subcortical group (16.68 +/- 5.70 ng/dl vs. 10.98 +/- 3.34 ng/dl, p < 0.05). NIHSS on admission and on the 7th day correlated with the initial serum NSE level (p < 0.05), as were more severe functional outcomes, as determined 3 months after onset (p < 0.05). This study shows that initial serum NSE level may be a useful marker for severity in acute ischemic stroke, and that it may be well correlated with short-term and long-term functional outcomes.
急性脑梗死患者功能预后的预测取决于多种因素。已应用多种技术来预测脑梗死的严重程度和预后。神经元特异性烯醇化酶（NSE）是一种特定脑酶的组成部分，是脑损伤的有用标志物。我们评估了59例急性脑梗死患者和38例年龄匹配的健康对照者初始血清NSE水平与短期和长期临床预后之间的关系。在发病24小时内测定颈动脉（CA）区域脑梗死患者的血清NSE水平。中风后4至7天进行脑部MRI检查。患者分为两组：病变累及皮质的大面积CA区域梗死（皮质组）和病变局限于皮质下白质的小面积皮质下CA区域梗死（皮质下组）。我们比较了两组的初始血清NSE水平。在入院时和发病后7天测定美国国立卫生研究院卒中量表（NIHSS），并在发病后3个月随访时使用改良Rankin量表。与正常对照组相比，急性脑梗死患者的血清NSE水平显著升高（13.88±5.47 ng/dl对8.15±1.53 ng/dl，p<0.05）。皮质组的初始（<24小时）血清NSE水平高于皮质下组（16.68±5.70 ng/dl对10.98±3.34 ng/dl，p<0.05）。入院时和第7天的NIHSS与初始血清NSE水平相关（p<0.05），发病后3个月确定的功能预后更差也与之相关（p<0.05）。本研究表明，初始血清NSE水平可能是急性缺血性卒中严重程度的有用标志物，并且可能与短期和长期功能预后密切相关。
