CT血流灌注结合血脑屏障标志蛋白对中毒性休克患者神经元损伤的评价价值

选择2017年12月~2018年11月我院收治的100例经临床确认的中毒性休克患者的临床资料,所有患者均进行CT血流灌注成像检查,原始图像经工作站自带的脑灌注软件处理后产生灌注参数伪彩图像,测量病变侧及对侧大脑半球多个解剖部位的脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)等灌注参数,计算病变侧/对侧的对比值(rCBF、rCBV、rMTT、rTTP)。并使用免疫组学方法检测不同患者外周血及脑脊液中血脑屏障通透性与紧密连接蛋白claudin-5、occludin、ZO-1、JAM-1、NOS和NSE的表达水平变化,并比较灌注参数与血脑屏障标志蛋白水平的相关性。结果显示,观察组患者外周血及脑脊液rCBF显著下降,rTTP降低,rPS升高(P<0.05),但两组rMTT、rCBV比较,差异无统计学意义(P>0.05)。观察组患者外周血及脑脊液claudin-5、occludin、ZO-1、NOS显著下降,JAM-1、NSE明显升高(P<0.05)。观察组claudin-5、occludin、ZO-1和NOS与rCBF、rTTP呈正相关,与rPS呈负相关;JAM-1和NSE与rCBF、rTTP呈负相关,与rPS呈正相关。rCBF、rTTP、JAM-1、NSE与神经元损伤程度呈正相关,claudin-5、occludin、ZO-1和NOS与神经元损伤程度呈负相关。上述结果表明CT血流灌注参数结合血脑屏障标志蛋白可有效评估中毒性休克患者神经元损伤程度,值得推广和应用。

Value of CT Perfusion Combined with Blood-brain Barrier Marker Protein in Evaluating Neuronal Damage in Patients with Toxic Shock

The clinical data of 100 patients with clinically confirmed toxic shock admitted to our hospital from December 2017 to November 2018 were selected.All the patients underwent CT perfusion imaging.The original images were processed by the perfusion software in the workstation to produce pseudo-color images of perfusion parameters.Cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),peak time(TTP)of the lesion side and the contralateral cerebral hemisphere was measured,and other perfusion parameters(rCBF,rCBV,rMTT,rTTP)were used to calculate the relative ratio of lesion side to opposite side.The expression of claudin-5,occludin,ZO-1,JAM-1,NOS and NSE in different patients were detected by immunohistochemical method,and the correlation between the protein levels and the perfusion paraneters was compared.The results showed that rCBF in peripheral blood and cerebrospinal fluid decreased significantly,rTTP decreased and rPS increased significantly in the observation group(P<0.05),but there was no significant difference in rMTT and rCBV between the two groups(P>0.05).The claudin-5,occludin,ZO-1 and NOS in peripheral blood and cerebrospinal fluid of the patients in the observation group decreased significantly,while JAM-1 and NSE increased significantly(P<0.05).In the observation group,claudin-5,occludin,ZO-1 and NOS were positively correlated with rCBF and rTTP,negatively correlated with rPS;JAM-1 and NSE were negatively correlated with rCBF and rTTP,and positively correlated with rPS.rCBF,rTTP,JAM-1 and NSE were positively correlated with neuronal injury,while claudin-5,occludin,ZO-1 and NOS were negatively correlated with neuronal injury.It is suggested that CT blood perfusion combined with blood brain barrier marker protein can effectively evaluate neuronal damage in patients with toxic shock,and it is worth popularizing and applying.