目的 探讨急性脑出血(ICH)患者血浆和脑脊液中β-内啡肽、促性腺激素释放激素(GnRH)水平变化及其对脑损伤程度和预后的影响.方法 89例ICH患者为病例组,按照斯堪的纳维亚卒中量表(SSS)评分将其分为轻型ICH组(SSS评分 0~15分,n=41)、中型ICH组(SSS评分 16~30分,n=28)、重型ICH组(SSS评分31~45分,n=20例),按照格拉斯哥预后量表(GOS)评分将其分为预后良好组(GOS评分4~5分,n=63)、预后不良组(GOS评分1~3分,n=26).采用放射免疫法对患者入院后1、3、7、14、30 d血浆和脑脊液中β-内啡肽、GnRH水平进行检测.并于同期选取30例无神经系统疾病且行腰穿麻醉术的患者为对照组.结果 随着入院时间延长,轻型、中型、重型ICH患者血浆、脑脊液中β-内啡肽、GnRH水平均呈逐渐下降趋势(P均<0.05).病例组入院后1、3、7、14 d血浆、脑脊液β-内啡肽、GnRH水平均高于对照组(P均<0.05),轻型、中型、重型ICH组间两两比较,P均<0.05.入院30 d时,中型、重型ICH组血浆、脑脊液β-内啡肽、GnRH水平高于轻型ICH组、对照组,重型ICH组血浆、脑脊液β-内啡肽、GnRH水平高于中型ICH组(P均<0.05).预后良好组入院1、3、7、14、30 d血浆、脑脊液β-内啡肽、GnRH水平均低于预后不良组(P均<0.05).结论 ICH患者血浆和脑脊液中β-内啡肽、GnRH水平升高,其水平升高可致脑损伤程度加重,预后变差.%Objective To investigate the changes in levels of β-endorphin and gonadotropin releasing hormone (GnRH) in the blood and cerebrospinal fluid of patients with acute intracerebral hemorrhage (ICH) and its influence on the degree and prognosis of brain injury.Methods Eighty-nine patients with acute ICH were selected as the case group.According to the Scandinavian Stroke Scale (SSS) score, the patients in the case group were divided into the mild ICH group (SSS: 0-15, n=41), moderate ICH group (SSS: 16-30, n=28), and severe ICH group (SSS: 31-45, n=20).According to the Glasgow prognosis scale (GOS), the patients in the case group were divided into the good prognosis group (GOS: 4-5, n=63) and poor prognosis group (GOS: 1-3, n=26).The β-endorphin and GnRH levels in the blood and cerebrospinal fluid on day 1, 3, 7, 14, and 30 after admission were detected by the radioimmunoassay.Thirty patients without neurological diseases undergoing lumbar anesthesia were selected as the control group.Results The β-endorphin and GnRH levels in the blood and cerebrospinal fluid in the mild ICH group, moderate ICH group, and severe ICH group showed a decreasing trend with the gradual extension of admission time (P<0.05).The β-endorphin and GnRH levels in the blood and cerebrospinal fluid of the case group on day 1, 3, 7, and 14 after admission were higher than those of the control group, and the difference was statistically significant between groups of mild ICH group, moderate ICH group, and severe ICH group (both P<0.05).On day 30 after admission, the β-endorphin and GnRH levels in the blood and cerebrospinal fluid of the moderate ICH group and severe ICH group were higher than those of the mild ICH group and control group, and those of the severe ICH group were higher than those of the moderate ICH group (both P<0.05).The β-endorphin and GnRH levels in the blood and cerebrospinal fluid of the good prognosis group on day 1, 3, 7, 14, and 30 after admission were lower than those of the poor prognosis group, and the difference was statistically significant (both P<0.05).Conclusion The β-endorphin and GnRH levels in the blood and cerebrospinal fluid of ICH patients increase, which can cause the severer brain injury and poorer prognosis.
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