Yang Rui-Ling, Wu Cheng-Han, Wang Kai-Yu
Department of Neurology, Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350003.
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2012 Mar;32(3):338-42.
To study the relationship between the expressions of thrombin-antithrombin (TAT) complex and excess syndrome of stroke (ESS) and depletion syndrome of stroke (DSS) by dynamically observing the expressions of TAT complex in the plasma and hematoma fluid of intracerebral hemorrhage (ICH) patients.
Sixty patients were assigned to three groups according to syndrome typing, i.e., as yang excess group (18 cases), yin excess group (22 cases), and depletion syndrome group (20 cases). The hemorrhage volume was assessed. NIHSS and GCS were scored. Besides, 30 healthy volunteers at the Physical Examination Center, Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine were recruited as the normal control group. Another 10 patients in need of lumbal anesthesia were recruited as the cerebrospinal fluid control group, who suffered from surgical, gynecologic pelvic diseases, or diseases from lower limbs, but unaccompanied with cardio-/cerebrovascular diseases. The expressions of TAT complex were detected in the venous blood and hematoma fluid of the patient groups and in the venous blood or the cerebrospinal fluid of the control group using ELISA.
The syndromes were sequenced as the depletion syndrome > the yin excess syndrome > the yang excess syndrome according to the hemorrhage volume and NIHSS score. They were sequenced as the yang excess syndrome > the yin excess syndrome >the depletion syndrome according to the GCS score. The plasma TAT complex content on the 4th day in the ICH group was lower than that at the rest time points, showing statistical significance (P<0.01). Compared with the normal control group, the plasma TAT complex on the 1st, 2nd, and 4th day all increased with statistical difference (P<0.01). Statistical significance of the TAT complex in the hematoma fluid of the ICH group existed when compared it on the 1st, 2nd, and 4th day (P<0.01). Compared with the cerebrospinal fluid control group, the contents of the TAT complex in the hematoma fluid of the ICH group increased with statistical difference (P<0.01). The hemorrhage volume of ICH patients was positively correlated with NIHSS (r=0.809, P<0.01) and negatively correlated with GCS (r=-0.833, P<0.01). The TAT complex was obviously higher in the ICH group than in the two control groups in a dynamic way (P<0.01). There was obvious difference in the expressions of TAT among yang excess group, yin excess group, and depletion syndrome group (P<0.01). The expressions of TAT in the plasma and the hematoma fluid of the ICH group were negatively correlated with GCS score and positively correlated with NIHSS score (both P<0.01).
TAT complex participated in secondary neuron injury after ICH, which could be taken as an objective index for clinical observation. It also could provide evidence for syndrome quantification of excess syndrome and depletion syndrome.
通过动态观察脑出血(ICH)患者血浆及血肿液中凝血酶 - 抗凝血酶(TAT)复合物的表达,研究其与中风实证(ESS)和中风虚证(DSS)的关系。
将60例患者按证型分为三组,即阳盛组(18例)、阴盛组(22例)和虚证组(20例)。评估出血量,进行美国国立卫生研究院卒中量表(NIHSS)评分和格拉斯哥昏迷量表(GCS)评分。此外,招募福建中医药大学附属第二人民医院体检中心的30名健康志愿者作为正常对照组。另招募10例需要腰麻的患者作为脑脊液对照组,这些患者患有外科、妇科盆腔疾病或下肢疾病,但无心血管/脑血管疾病。采用酶联免疫吸附测定(ELISA)法检测患者组静脉血和血肿液以及对照组静脉血或脑脊液中TAT复合物的表达。
根据出血量和NIHSS评分,证型顺序为虚证>阴盛证>阳盛证。根据GCS评分,证型顺序为阳盛证>阴盛证>虚证。ICH组第4天血浆TAT复合物含量低于其余时间点,差异有统计学意义(P<0.01)。与正常对照组相比,ICH组第1、2、4天血浆TAT复合物均升高,差异有统计学意义(P<0.01)。ICH组血肿液中TAT复合物在第1、2、4天比较差异有统计学意义(P<0.01)。与脑脊液对照组相比,ICH组血肿液中TAT复合物含量升高,差异有统计学意义(P<0.01)。ICH患者出血量与NIHSS呈正相关(r = 0.809,P<0.01),与GCS呈负相关(r = -0.833,P<0.01)。ICH组TAT复合物动态变化明显高于两个对照组(P<0.01)。阳盛组、阴盛组和虚证组TAT表达有明显差异(P<0.01)。ICH组血浆和血肿液中TAT表达与GCS评分呈负相关,与NIHSS评分呈正相关(均P<0.01)。
TAT复合物参与ICH后继发性神经元损伤,可作为临床观察的客观指标,也可为实证和虚证的证候量化提供依据。