不同程度颅脑损伤后炎症因子的表达及其临床意义

Expression of inflammatory cytokines after traumatic brain injury and its clinical significance

摘要:

目的  探讨颅脑创伤（TBI）后炎症因子[肿瘤坏死因子（TNF-α）、白介素-6（IL-6）及C-反应蛋白（CRP）]与颅脑损伤程度、继发性颅脑损伤（SCI）的关系。方法  选取98例TBI患者，根据急性闭合性TBI的分型标准分为轻型、中型及重型TBI，分别为轻型组（29例）、中型组（41例）及重型组（28例），42例健康志愿者作为对照组；分别于TBI后1、3、5、7及12 d取外周静脉血，采用免疫组织化学法（SP）检测患者的TNF-α、IL-6及CRP表达水平，计算脑出血量及脑水肿体积。结果  TBI后1、3、5、7及12 d血清TNF-α、IL-6及CRP表达水平均先升高，再下降；但TBI后各个时间点的血清TNF-α、IL-6及CRP表达水平均高于对照组（P <0.05）；TBI后1、3及5 d脑出血量逐渐增多、脑水肿体积逐渐增大，TBI后7及12 d脑出血量逐渐减少、脑水肿体积逐渐减小；重型组各个时间点的血清TNF-α、IL-6及CRP表达水平均高于轻型组及中型组（P <
0.05）；中型组各个时间点的血清TNF-α、IL-6及CRP表达水平均高于轻型组（P <0.05）；TBI后TNF-α、IL-6及CRP表达水平与TBI程度、脑出血量及脑水肿体积呈正相关（P <0.05）。结论  TBI程度、脑出血量及脑水肿体积与血清TNF-α、IL-6及CRP表达水平呈单峰性升降密切相关，可作为TBI病情评估、疗效及预后的检测指标，为TBI采取免疫抑制治疗提供依据。

Abstract:

 Objective To explore the relationship between inflammatory factors (TNF-α, IL-6 and CRP) following traumatic brain injury (TBI) and brain injury degree and secondary cerebral injury (SCI). Methods According to the criterion for classification of acute closed TBI, 98 patients were divided into mild group (29 cases), moderate group (41 cases) and severe group (28 cases). During the same period, 42 healthy volunteers were selected as the control group. The peripheral blood was taken 1, 3, 5, 7 and 12 d after TBI. Immunohistochemistry SP method was used to detected TNF-α, IL-6 and CRP expression levels; and cerebral hemo-rrhage amount and cerebral edema volume were calculated. Results Serum TNF-α, IL-6 and CRP expressions first increased, and then decreased 1, 3, 5, 7 and 12 d after TBI. However, serum TNF-α, IL-6 and CRP expression levels at each time point after TBI were significantly higher in the TBI patients than those in the control group (P < 0.05). Cerebral hemorrhage and cerebral edema volume gently increased 1, 3 and 5 d after TBI, but gradually declined 7 and 12 d after TBI. Serum TNF-α, IL-6 and CRP expression levels in the severe group were significantly higher than those in the mild and moderate groups at each time point (P < 0.05). Serum TNF-α, IL-6 and CRP expression levels in the moderate group were significantly higher than those in the mild group at each time point (P < 0.05). TNF-α, IL-6 and CRP expression levels following TBI were positively correlated with cerebral hemorrhage and cerebral edema (P < 0.05). Conclusions Serum TNF-α, IL-6 and CRP levels show single-peak shapes and are closely related to TBI degree, cerebral hemorrhage and cerebral edema volume. They could be used as indexes for assessment of disease, treatment effect and prognosis of TBI, and also provide the basis for immunosuppressive therapy.