| Objective：Intracerebral hemorrhage(ICH) is one of the most commonacute cerebrovascular disease which accounted for20%~30%of the totalstroke cases in China. A study showed that more than30%of the cases withneurological dysfunction. One of the reasons is oppression of the hematoma.But the late-onset edema after ICH and the damage of toxic substances aremore important reasons. Therefore, there is great significance to research onthe mechanism of neural injury after ICH in order to improve the treatmentand prognosis. Studies showed that iron played an important role in theformation of late-onset edema and nerve injury after ICH. There are not somany researches on whether Serum ferritin (SF) which is the storage form ofiron can be an indicator of brain edema, or whether it is related to theprognosis of ICH. Recent research showed that the uric acid was related to theprognosis of acute cerebrovascular disease, but there was no consensusconclusion. The purpose of this study was to explore the relationship betweenthe changes of SF, uric acid and the prognosis of ICH in order to providereliable basis for early assessment of prognosis, to improve treatment and toreduce morbidity.Methods：32patients with spontaneous ICH who were hospitalized inneurology department from October2012to October2013were confirmed bybrain CT and the diagnostic criteria for spontaneous intracerebral hemorrhage.It included20males and12females, mean age65.09±11.95. Data includedthe risk factor, NIHSS score, calculated hematoma volume, SF, uric acid,biochemical test, blood glucose, white blood cells. Unicle800biochemicalanalyzer produced by the United States BECKMANCOULTER was applied tomeasure changes in uric acid on the admission,7d,14d, using enzymaticmethod of uric acid. Also ECLIA immune luminescence was applied to detect changes in SF levels on the admission,3d,7d,14d with German company’sE601Roche electrochemiluminescence instrument and compare the resultswith30healthy people. If the patient’s condition was steady, the head CT werereviewed on3d and the hematoma and edema volume were calculatedaccording to Tada formula. NIHSS score and modified Rankin score (MRS)were also used on follow-up patients in90d to assess the recovery ofneurological function and life skills. According to MRS score patients weredivided into good prognosis group (MRS≤2) and poor prognosisgroup(MRS>2). SPSS13.0statistical software was used for data analysis, and ttest was used for data in line with the normal distribution and others usingnon-parametric tests. Spearman correlation analysis was applied forcorrelationship and multiple linear regression was used in multivariateanalysis.Results:1Risk factors affecting the prognosis of ICH: After excluding the impactof bleeding position, the study showed that age, admission blood pressure,blood glucose, white blood cell count, amount of bleeding, SF levels are riskfactors affecting the prognosis of ICH.2Clinical outcome: within the32patients,18cases were in goodprognosis group (MRS≤2), while14cases were in poor prognosis group(MRS>2), in which two cases were dead(one was died of central respiratoryand circulatory failure, the other was died of Multiple organ failure).3Changes in SF levels: the SF levels of the32patients began to rise onthe3d(232.34±106.62ng/ml), and then reached a peak level on7d(245.11±109.52ng/ml), and then dropped on the14d （224.40±106.34ng/ml）, which had a significant difference (P values were0.005,0.001and0.046) compared with the control group(163.54±59.41ng/ml).4Relations between SF levels and prognosis: SF levels between goodprognosis group and poor prognosis group were statistically significantdifferent at every observation point: the higher of the SF level, the worse ofthe prognosis. SF of good prognosis group on the admission，3d,7d,14d are respectively141.47±82.09ng/ml，181.77±97.29ng/ml，198.17±96.63ng/ml，159.59±72.43ng/ml, while211.79±100.26ng/ml，297.36±81.48ng/ml，305.45±97.05ng/ml，307.74±82.54ng/ml for the poor prognosis group.Multiple linear regression analysis showed that SF is an independent riskfactor for prognosis of ICH.5Relationship between SF levels and hematoma, edema volume: therewas no significant correlation between serum SF and edema volume(r=0.276，P=0.127) as well as hematoma volume(r=0.28，P=0.121) on the admission;But after the3d, SF levels began to rise, which was positively correlated withedema volume (r=0.402，P=0.022) and hematoma volume as well(r=0.520，P=0.002).6Changes of uric acid levels and the relationship between it andprognosis of ICH: the uric acid levels of32patients are239.38±69.74umol/L,245.26±76.52umol/L,220.18±58.26umol/L on theadmission,7d and14d and there was no significant difference in uric acidlevels between good prognosis group and poor prognosis group(P valueswere0.627,0.453and0.498). Comparing with the control group, there was nosignificant difference in uric acid levels at every time point(P>0.05).Conclusion:1The prognosis of patients with ICH was related to age, blood pressureafter admission, blood glucose, numbers of white blood cell, amount ofbleeding, SF levels and other factors.2SF level could be a independent risk factor affecting the prognosis ofpatients with ICH, which can assess prognosis early. The higher of the SF, theworse of the prognosis. The mechanism may be related to oxidative stressdamage.3The variation of SF after ICH was as follows: the SF levels began torise rapidly on3d, and reached a peak level on7d and was still higher than thecontrol group on14d. The variation provides effective clues for the furtherresearch of clinical interventions.4There was no relationship between serum uric acid levels and the prognosis of ICH. |
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