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目的:探讨兴奋性氨基酸谷氨酸与脑梗死出血转化关系的研究。方法:连续收集2011年7月至2016年8月郑州大学附属洛阳中心医院神经内科住院的脑梗死患者66例为病例组,根据头颅计算机断层扫描(CT)检查有无出血转化分为出血性转化(HT)组和非出血转化(non–HT)组;收集本院健康体检中心体检的健康人33例为对照组。均用高效液相色谱法检测患者血清谷氨酸水平。结果患者HT组血清谷氨酸水平(133.10±16.58)μmol·L~(-1)明显高于non–HT组(110.15±19.73)μmol·L~(-1)和对照组(91.08±8.76)μmol·L~(-1),差异具有统计学意义(P<0.05)。发病不同时间点,3 d内、3~8 d、8 d及以后HT组血清谷氨酸水平均高于同时间点non–HT组,差异具有统计学意义(P<0.05)。HT组血清谷氨酸水平3 d内即明显升高,8 d后明显降低,差异有统计学意义(P<0.05);出血转化组不同亚型出血性梗死(HI)组和脑血肿形成(PH)组血清谷氨酸水平差异无统计学意义(P>0.05);血清谷氨酸水平预测出血转化的界值是125.02μmol·L~(-1),当谷氨酸≥125.02μmol·L~(-1)时,脑梗死出血转化的灵敏度为81.3%,特异度为76.1%,阳性预测值46.67%,阴性预测值96.36%。结论通过检测血清谷氨酸水平对脑梗死出血转化进行早期预测、预防,指导临床治疗、改善预后有重要意义。
Objective: To investigate the relationship between excitatory amino acid glutamate and hemorrhage after cerebral infarction. Methods: Sixty-six patients with cerebral infarction who were hospitalized in Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University from July 2011 to August 2016 were enrolled in this study. The patients were divided into hemorrhagic transformation according to cranial computed tomography (CT) (HT) group and non-hemorrhagic transformation (non-HT) group. 33 healthy subjects collected from the physical examination center of our hospital served as the control group. Patients with serum glutamate levels were detected by high performance liquid chromatography. Results The level of serum glutamate (133.10 ± 16.58) μmol·L -1 in HT group was significantly higher than that in non-HT group (110.15 ± 19.73 μmol·L -1) and control group (91.08 ± 8.76) μmol·L -1, the difference was statistically significant (P <0.05). At different time points, the levels of serum glutamic acid in HT group were higher than those in non-HT group at 3 days, 3 days, 8 days, 8 days and later. The difference was statistically significant (P <0.05). The levels of serum glutamate in HT group increased significantly within 3 days and decreased significantly after 8 days (P <0.05). The levels of glutamate in different subtypes of hemorrhagic transformation group and hematoma formation (P> 0.05). The cutoff value of serum glutamate level was 125.02μmol·L ~ (-1) when glutamate level was above 125.02μmol·L ~ (-1), the sensitivities of cerebral infarction hemorrhage transformation were 81.3%, specificity was 76.1%, positive predictive value 46.67%, negative predictive value 96.36%. Conclusion It is of great significance to detect the level of glutamate in the early stage of cerebral infarction hemorrhage and to prevent, guide the clinical treatment and improve the prognosis.