| Objective Hypertensive intra-cerebral hemorrhage (HICH) is the primary non-traumatic brain parenchymal hemorrhage in the case of hypertension. The rates of mortality and disability are high. With the further researches on cerebral hemorrhage in recent years, more and more people have paid close attention to intra-cerebral hemorrhage and its degradation products in the brain tissue injury and brain edema formation, in which thrombin possibly plays a very important role. Currently, researches on the association between thrombin and edema are mainly based on zoopery. However, little research has been found in clinical field. This research aims at making a clinical study on thrombin, cerebral edema and blood-brain barrier (BBB) index of hypertensive intra-cerebral hemorrhage, and approaching the roles that thrombin plays in the formation of brain edema. As a result, this research possibly better provides new theoretical bases to the clinic.Methods Cases were selected in accordance with the standards and strictly screening cases. The experiment involved three groups. 30 patients with essential hypertension were recruited in hypertension control group, and each of them was taken 2-3 ml of vein blood, measured the concentrations of thrombin. 30 patients with cerebral hemorrhage involved in conventional therapy group, taken peripheral blood and measured the concentrations of thrombin at the 1st, the 3rd, the 5th and the 7th days respectively. 32 patients with cerebral hemorrhage were enrolled in the minimal invasive treatment group, measured the concentrations of thrombin in blood clot by the needle side of the cranial drill Aspiration, taken peripheral blood and measured the concentrations of serum thrombin at the 1st, the 3rd, the 5th and the 7th days respectively. Brain CT was performed in patients in conventional therapy group and minimal invasive treatment group in order to detect the ratio of brain edema, BBB index and neurologic impairment score. The concentrations of thrombin in the peripheral blood and hematoma fluid, BBB index, neurologic impairment score and the imageology ratio of brain edema were recorded. Groups were compared through the analysis of variance. The Mean and SD(x|-±s) was generated with Statistical Package for Social Science 13.0 (SPSS13.0). Level of significance was set to 0.05.Results1. The concentration of serum thrombin reached the peak level at the 3rd day both in conventional therapy group and minimal invasive treatment group (p<0.05) . Howerer the concentration of serum thrombin in minimal invasive treatment group reached the peak level rapidly at the 3rd day (p<0.05) . There was no significant difference observed in the concentrations of serum thrombin between the two groups (p >0.05) .2. The ratio of cerebral edema reached the peak at the 3rd and the 5th days both in conventional therapy group and minimal invasive treatment group (p<0.05 ) . There was no significant difference observed in the ratio of cerebral edema between the two groups at the 1st and the 3rd days (p >0.05). However the ratio of cerebral edema in conventional therapy group was significantly higher than that in minimal invasive treatment group at the 5th and the 7th days.3. The BBB index reached the peak level at the 3rd and the 5th days in conventional therapy group (p<0.05) , and at the 3rd day in minimal invasive treatment group(p<0.05). There was no significance observed in the BBB index at the 1st and the 3rd days between the two groups. However the BBB index in conventional therapy group was significantly larger than that in minimal invasive treatment group at the 5th and the 7th days.4. The neurologic impairment scores in the 3rd and the 5th days were higher than those in conventional therapy group in the 1st and the 7th days. The neurologic impairment score in minimal invasive treatment group reached the peak level at the 3rd day (p<0.05) . There was no significance observed in neurologic impairment scores in the 1 st and the 3rd days between the two groups. However the neurologic impairment scores in conventional therapy group were significantly higher than those in minimal invasive treatment group at the 5th and the 7th days (p<0.05 ).5. The concentration of serum thrombin and the ratio of brain edema were positively correlated in conventional therapy group(r=0.811,p<0.05) . The concentration of hematoma thrombin and the ratio of brain edema were positively correlated in minimal invasive treatment group (r=0.782,p<0.05) .6. The concentration of thrombin in hematoma and BBB index were significantly correlated in minimal invasive treatment group(r=0.829,p<0.05) . BBB index and the ratio of brain edema were significantly correlated in conventional therapy group7. The concentration of thrombin in hematoma and neurologic impairment score were significantly correlated (r=0.735,p<0.05 ) in minimal invasive treatment group. The ratio of brain edema and neurologic impairment score were significantly correlated in conventional therapy group (r=0.889,p<0.05) .Conclusion1. Thrombin can increase the permeability of the blood-brain barrier and cause the formation of the cerebral edema in patients with cerebral hemorrhage. 2. The minimally invasive treatment can not completely mitigate the blood-brain barrier damage and the formation of cerebral edema induced by thrombin in cerebral hemorrhage at the early period (≤3 days).3. Minimally invasive treatment can mitigate the blood-brain barrier damage, the formation of cerebral edema and neurologic impairment score at the later stage of cerebral hemorrhage (>3days).
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