クモ膜下出血，脳内出血症例における血清Neuron-specific Enolase値についての検討

Measurement of Serum Neuron-specific Enolase Levels after Subarachnoid Hemorrhage and Intracerebral Hemorrhage

I．はじめに

　解糖系酵素の1つであるenolaseは，α，β，γ，という三種類のsubunitからなる二量体で，γ—subunitを有する（αγとγγ）isozymeがneuron-specific enolase（NSE）と呼ばれている．NSEは神経細胞と軸索に局在し^11），神経損傷時に髄液中や血液中に逸脱するとされている^{3,5-7,10,12）}．しかし，現在では神経芽細胞腫や肺癌などの腫瘍マーカーとして臨床応用されているのみで，中枢神経系の外傷^6）や疾患^3,5,7）に際しての報告は，散見されるもののいまだ不十分である．今回われわれは，クモ膜下出血症例と脳内出血症例において，血清NSE濃度を測定したので報告する．

Neuron-specific enolase (NSE) is an enzyme involved in glycolysis and has a gamma-subunit. It is localized in neurons and axonal processes, and escapes into the blood and cerebrospinal fluid at the time of neural in-jury. In this study, the serum NSE levels in cases of subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (HIH) were measured. The subjects were 20 patients with subarachnoid hemorrhage (mean age; 53.4±14.5, 12 men and 8 women) and 20 with hypertensive intracerebral hemorrhage (mean age;57.9±13.6, 11 men and 9 women). Although the serum NSE levels of all of these patients were measured on admission, measurement in patients with SAH were serially measured for an additional three weeks. There was no correlation between the serum NSE levels on admission in patients with SAH and con-sciousness level or clinical grade on admission, or pro-gnosis. However, in Fisher's CT group 3 or 4, patients showed significantly higher levels of NSE than pa-tients in group 2. Seven patients in whom vasospasm was observed by cerebral angiography during the course of treatment demonstrated elevated serum NSE levels from the 5th to the 15th days. In cases of HIH, there was also no correlation between the serum NSE levels from admission and consciouness level on admis-sion or prognosis. However, the relationship between the size of the hematoma and serum NSE level on admission was significantly higher in patients in whom the maximum diameter was 5cm or more in comparison to those in whom the maximum diameter was less than 5cm. These findings suggest that measurement of serum NSE levels in patients with SAH and HIH is useful for evaluating the extent of injury to the cerebral parenchyma.