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目的探讨小剂量胰岛素对脑出血后应激性血糖增高患者血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)水平的影响及临床意义。方法选2011年10月至2012年11月在辽宁医学院附属第三医院66例既往无糖尿病史、出血量15~30 mL的基底节脑出血且血糖值为7.8~11.1 mmol·L?1患者,随机分为胰岛素治疗组(n=34)及常规治疗组(n=32)。正常对照组(n=30),为同期健康体检者。治疗组每2 h检测1次血糖,以预防低血糖。用ELISA法动态测定血清中NSE的水平,治疗期间脑血肿变化,及评定治疗组患者治疗期间神经功能缺损评分,并随访3个月后观察比较患者预后。结果胰岛素治疗组及常规治疗组患者均在12 h内NSE水平较正常对照组开始升高(P<0.01),治疗组在24 h内差异无统计学意义;胰岛素治疗组在第3天达到峰值并开始下降,常规治疗组7 d达到峰值并开始下降,胰岛素治疗组在3 d内与常规治疗组比较不具有统计学意义,7 d后与常规治疗组比较有显著性差异(P<0.01);胰岛素治疗组21 d内均高于正常对照组,28 d与正常对照组差异无统计学意义;常规治疗组到28 d时NSE水平均高于正常对照组(P<0.01)。治疗第14天、第28天,胰岛素治疗组血肿体积明显小于常规治疗组(P<0.01)。在14 d、28 d的胰岛素治疗组的神经功能缺损评分与常规治疗组相比差异有统计学意义(P<0.05)。3个月后随访,2组治疗组ADL分级比较差异有统计学意义(P<0.05)。结论脑出血继发应激性血糖增高患者早期应用胰岛素治疗可以保护神经元,改善神经功能缺损,减少神经细胞损害及脑出血后的继发性损伤,促进神经功能恢复,改善患者预后。
Objective To investigate the effect and clinical significance of low dose insulin on serum level of neuron-specific enolase (NSE) in patients with stress-induced hyperglycemia after intracerebral hemorrhage. Methods From October 2011 to November 2012, 66 patients with past history of no history of diabetes mellitus and 15 to 30 mL of bleeding in the third affiliated hospital of Liaoning Medical College were enrolled in this study. The blood glucose of 7.8 ~ 11.1 mmol·L -1 patients Were randomly divided into insulin treatment group (n = 34) and conventional treatment group (n = 32). Normal control group (n = 30), for the same period of health examination. The treatment group tested blood glucose every 2 hours to prevent hypoglycemia. The level of NSE in serum, the change of cerebral hematoma during the treatment, and the score of neurological deficit in the treatment group were evaluated by ELISA. The prognosis was observed and compared after 3 months of follow-up. Results The levels of NSE in the insulin treatment group and the routine treatment group were significantly higher than those in the normal control group within 12 hours (P <0.01), and there was no significant difference in the treatment group within 24 hours; the insulin treatment group reached the peak on the 3rd day And began to decline. The routine treatment group reached the peak on the 7th day and began to decline. Insulin treatment group had no statistical significance on the 3rd day compared with the conventional treatment group, and there was significant difference on the 7th day compared with the conventional treatment group (P <0.01) ; Insulin treatment group 21 d higher than the normal control group, 28 d and the normal control group no significant difference; the normal treatment group 28 d NSE levels were higher than the normal control group (P <0.01). On the 14th day and the 28th day of treatment, the volume of hematoma in the insulin treatment group was significantly smaller than that in the conventional treatment group (P <0.01). At 14 and 28 days, the difference of neurological deficit score between the insulin treatment group and the conventional treatment group was statistically significant (P <0.05). After 3 months’ follow-up, there was significant difference in ADL classification between the two groups (P <0.05). Conclusions Early insulin treatment in patients with stress hyperglycemia secondary to cerebral hemorrhage can protect neurons, improve neurological deficits, reduce neuronal damage and secondary injury after cerebral hemorrhage, promote neurological function recovery and improve prognosis.