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观察糖皮质激素治疗脑出血后脑水中患者过程中血清MDA、MMP-9和ICAM-1水平的变化,探讨这种变化与糖皮质激素治疗脑出血后脑水肿的疗效关系。2010年1月至2015年12月入院的脑出血患者100例,按随机数字表法分为两组,分为常规治疗组50例和GC组50例。健康体检对照组50例。检测脑出血患者不同时间血清中的MDA、MMP-9和ICAM-1水平,通过CT检查计算同时间的脑水肿体积。TBA法检测MDA含量,酶联免疫吸附试验检测血清MMP-9和ICAM-1水平。入院24 h内,常规治疗组和GC组血清MDA含量,MMP-9和ICAM-1水平均高于健康对照组(p<0.05)。24 h内常规治疗组与GC组比较,脑水肿体积、MDA、MMP-9和ICAM-1差异均无统计学意义。而治疗后7 d和14 d,GC组与常规治疗组比较,脑水种体积、MDA、MMP-9和ICAM-1均减少(p<0.05),GC组MMP-9和ICAM-1与脑水肿体积呈正相关(r=0.881,r=0.845,r=0.861,p<0.05)。治疗后14 d,GC组MDA与脑水肿体积无相关性。糖皮质激素可能通过降低ICMA-1和MMP-9表达,消除自由基等机制减少脑出血后脑水肿程度。
To observe the changes of serum MDA, MMP-9 and ICAM-1 levels in patients with cerebral hemorrhage after glucocorticoid treatment of cerebral hemorrhage and to explore the relationship between the changes and the therapeutic effect of glucocorticoid on cerebral edema after intracerebral hemorrhage. One hundred patients with ICH admitted from January 2010 to December 2015 were divided into two groups according to the random number table. They were divided into two groups: conventional treatment group (50 cases) and GC group (50 cases). 50 healthy control group. The levels of MDA, MMP-9 and ICAM-1 in sera of patients with intracerebral hemorrhage were detected at different times. The volume of cerebral edema at the same time was calculated by CT. TBA method was used to detect the content of MDA. Serum MMP-9 and ICAM-1 levels were detected by enzyme linked immunosorbent assay. Within 24 h of admission, the levels of serum MDA, MMP-9 and ICAM-1 in routine treatment group and GC group were higher than those in healthy control group (p <0.05). There was no significant difference in the volume of brain edema, MDA, MMP-9 and ICAM-1 between the conventional treatment group and the GC group within 24 h. Compared with the conventional treatment group, the volume of brain water, MDA, MMP-9 and ICAM-1 in GC group decreased (P <0.05) on the 7th day and the 14th day after treatment. The expression of MMP-9 and ICAM- Edema volume was positively correlated (r = 0.881, r = 0.845, r = 0.861, p <0.05). At 14 days after treatment, there was no correlation between MDA and brain edema volume in GC group. Glucocorticoids may reduce the degree of cerebral edema after intracerebral hemorrhage by reducing the expression of ICMA-1 and MMP-9 and eliminating the mechanisms of free radicals.