急性自发性基底节出血后血浆瘦素浓度的时间过程。
Time course of plasma leptin concentrations after acute spontaneous basal ganglia hemorrhage.
机构信息
Department of Neurosurgery, The First Hangzhou Municipal People's Hospital, Nanjing Medical University, Hangzhou, China.
出版信息
World Neurosurg. 2010 Aug-Sep;74(2-3):286-93. doi: 10.1016/j.wneu.2010.02.019.
BACKGROUND
Brain cortex leptin messenger ribonucleic acid (mRNA) expression and serum leptin level are up-regulated in ischemic mouse brain, as well as in rat brain with traumatic brain injury. Elevated leptin plasma levels predict cerebral hemorrhagic stroke independently of traditional risk factors. The goal of this study was to investigate change in plasma leptin level after intracerebral hemorrhage (ICH) and to evaluate its relation with disease outcome.
METHODS
Eighty-six patients admitted within 6 hrs after ICH and 30 healthy controls were included. Plasma samples were obtained on admission and at days 1, 2, 3, 5, and 7 after ICH. Its concentration was measured by enzyme-linked immunosorbent assay (ELISA).
RESULTS
After ICH, plasma leptin level in patients increased during the 6-hour period immediately, peaked in 24 hours, decreased gradually thereafter, and was substantially higher than that in healthy controls during the 7-day period. Plasma leptin levels were highly associated with initial Glasgow coma scores, ICH volumes, presence of intraventricular hemorrhage, and survival rates (all P < 0.05). A multivariate analysis selected plasma leptin level related to plasma C-reactive protein level (standardized coefficient, 0.293; P = 0.003). A multivariate analysis showed baseline plasma leptin level as a good predictor for 1-week mortality (odds ratio, 1.228; 95% confidence interval, 1.070-1.409; P = 0.003). A receiver operating characteristic curve identified that a baseline plasma leptin level greater than 34.1 ng/mL predicted 1-week mortality of patients with 75.0% sensitivity and 85.2% specificity (P < 0.001). Area under curve of GCS score was statistically significantly larger than that of plasma leptin level (P = 0.035), but ICH volume's area under curve not (P = 0.078).
CONCLUSIONS
Increased plasma leptin level is found after ICH and may contribute to inflammatory process of ICH, in association with a poor clinical outcome.
背景
脑皮质瘦素信使核糖核酸（mRNA）表达和血清瘦素水平在缺血性小鼠脑以及创伤性脑损伤大鼠脑均上调。升高的瘦素血浆水平可独立于传统危险因素预测脑出血性卒中。本研究的目的是研究脑出血（ICH）后血浆瘦素水平的变化，并评估其与疾病结果的关系。
方法
纳入 86 例发病 6 小时内的 ICH 患者和 30 名健康对照者。在发病时及 ICH 后第 1、2、3、5 和 7 天采集血浆样本。通过酶联免疫吸附测定（ELISA）测量其浓度。
结果
ICH 后，患者的血浆瘦素水平在发病后 6 小时内立即升高，24 小时内达到峰值，此后逐渐下降，7 天内明显高于健康对照组。血浆瘦素水平与初始格拉斯哥昏迷评分、ICH 体积、是否存在脑室内出血和生存率高度相关（均 P < 0.05）。多变量分析选择与血浆 C 反应蛋白水平相关的血浆瘦素水平（标准化系数，0.293；P = 0.003）。多变量分析显示，基线血浆瘦素水平是预测 1 周死亡率的良好指标（比值比，1.228；95%置信区间，1.070-1.409；P = 0.003）。ROC 曲线确定，基线血浆瘦素水平大于 34.1ng/mL 可预测 75.0%敏感性和 85.2%特异性的 1 周死亡率（P < 0.001）。GCS 评分曲线下面积在统计学上显著大于血浆瘦素水平（P = 0.035），但 ICH 体积曲线下面积则不然（P = 0.078）。
结论
ICH 后发现血浆瘦素水平升高，可能与 ICH 的炎症过程有关，并与不良临床结局相关。
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