Change In The Levels Of S100B/MMP-9in Serum And CSF After Two Minimally Invasive Surgical Methods For Intracerebral Hemorrhage And Their Relationship With Efficacy

Objective:To observe Whether there is some distinction on the levels of S100B and matrix metalloproteinase-9(MMP-9) in serum or cerebrospinal fluid(CSF) in the two groups, where patients respectively accept different minimally invasive surgical methods for intracerebral hemorrhage(ICH); and investigate the clinical value of the two biomarkers after surgical intervention. We also research the physiopathological change and the effect on prognosis resulted from the two different minimally invasive surgeries(MIS).Methods:On the grounds of enrollment criterion, there were a total of52ICH cases for treatment, divided into two groups:25cases were performed by Key-Hole Craniotomy (KHC group, KG) and24cases by Burr-Hole Drainage with Urokinase (BDU group, BG). Nevretheless,3cases were excluded from this comparative study for reoperation after BDU or KHC. Blood and CSF samples were collected from the rest49patients on admission and at days1,3,7,14after operation. Noraml control samples also were obtained:20blood samples and12CSF samples. S100B and MMP-9concentrations were measured by enzyme-linked immunosorbent assay. Hematoma volume(HV), intracerebral pressure (ICP) and volume of perihematoma edema(EV) were measured and analysed at the same time when taking samples. Also, other data were recorded, such as mean duration of operation, average hospital stay and the corresponding incidence of each kind of postoperative complications. The short-term outcomes were evaluated by NIHSS at postoperative14th and MRS at30th(MRS30d); the long-term prognosis was indicated by barthel index (BI)3months after operation.Results:1. The levels of S100B significantly was higher in serum and CSF in both operation groups than that of control group, in addition to MMP-9. The peak concentrations of the two biomarkers was attained at3rd postoperative day. The conentrations of S100B/MMP-9was significantly higher in KG compared with BG in serum, but conversely in CSF.2. Regardless of the grouping, partial data was analysed combining BG and KG:(1) Volume of perihematoma edema and NIHSS were highly associated with S100B levels at the same day, besides MMP-9in serum, but no significant correlation with the two biomarker in CSF;(2) MRS30d and serum S100B/MMP-9appeared postive relation markedly at each point in time, and the correlation coefficient is biggest at3rd day after operation(r=0.791, p=0.000; r=0.778, p=0.000), the critical value of S100B and MMP-9was1.41μg/1,18.12μg/1respectively, Logistic regression analyses showed that serum S100B (odds ratio,16.29;95%confidence interval,2.17-122.5, p=0.007) and MMP-9(odds ratio,15.83;95%confidence interval,1.31-191.6,p=0.03) were good predictors for short-term outcomes.3. At1st day after operation, there was significant difference between KG and BG in the percentages of ICH volume reduction (87.3%,48.8%, p=0.000), but no difference at14th day (98.2%,98.1%, p=0.308). ICP of KG is lower significantly than that of BG at1st day after operation, but higher than BG at3rd and7th days because of increaseing of Brain edema obviously, observing from the timeline of treatment, it is greater that ICP fluctuate in KG compared with BG, and the difference of individual ICP in KG is greater than that of BG at3rd postoperative day (heterogeneity of variance, F=6.946, p=0.012).4. Compared with those of BG, there was significantly longer operation time (4.1±0.67h,1.54±0.32h,p=0.000),longer hospital stays (34.7±16.6d、20.8±8.9d, p=0.001), more number of tracheotomy (x2=4.871, p=0.027)in KG.5. The short-term outcome of BG was better than KG(MRS30d:3.55±0.94、4.23±1.07, p=0.036), however, There was no significant difference in the long-term outcome between the two groups (BI:73.35±6.54、75.25±6.97, p=0.356).Conclusions:1. Increased serum levels of S100B and MMP-9, which are positively correlated with the degree of cerebral edema, may reflect the neuro-inflammation process after MIS for ICH.2. S100B/MMP-9can early predict the degree of brain injury and the recent neurological outcome after MIS, especially at crest-time of enceph aledema, the serum levels have better predictive value.3. KHC and BDU should be affirmed as effective minimally invasive surgery for ICH, which of those can achieve the purpose of clearing hematoma. The former is helpful for the patients with increased rapidly hematoma Within a short time after onset; the later is suitbale for the patients with no change in the volume of hematoma. The short-term outcome of BDU is better than that of KHC. But there are no difference in mortality and the long-term outcome between the two MIS.