颅脑创伤后血清抗脑抗体变化及免疫抑制研究  

A study on the changes of the antibrain - antibody and immunosuppression therapy after traumatic brain injury

作　　者：闫华[1] 徐鹏[1] 薛静[1] 侯永新[1] 段世博[1] 李冰[1] 张国斌[1] 刘暌[1] 只达石[1] 

机构地区：[1]天津市环湖医院神经外科,300060

出　　处：《中华神经外科杂志》2010年第2期155-158,共4页Chinese Journal of Neurosurgery

基　　金：天津市卫生局科技攻关基金（07KG3）;天津市环湖医院科技基金（08HHKY03）

摘　　要：目的研究重型颅脑创伤患者血清抗脑抗体变化趋势；探讨免疫抑制治疗对于创伤后兔脑组织的保护作用。方法ELISA法检测49例颅脑创伤患者和47例健康人的血清抗脑抗体浓度，时间点为伤后第3天、第7天、2周、3周、1、2、6、9个月；24只新西兰大白兔随机分为创伤组、免疫抑制组、假手术组；免疫抑制组伤后隔日口服环孢素A50mg，收集创伤前2h及伤后3、7、14、21、28、35、42、49d血清标本，检测血清抗脑抗体的浓度；50d后处死，取创伤周围皮层组织，用免疫组化法测定谷氨酸表达，TUNEL法测定细胞凋亡。结果颅脑创伤患者血清抗脑抗体明显高于健康人并持续较长时间；兔免疫抑制剂组血清抗脑抗体峰值较创伤组低；三组兔血清中抗脑抗体浓度两两比较差异有统计学意义（P〈0．05）；免疫抑制组兔创伤周围脑组织谷氨酸表达以及凋亡细胞明显低于颅脑创伤组（P〈0．05）。结论健康人群血清中存在少量抗脑抗体；颅脑创伤后血清中抗脑抗体较正常状态明显升高；免疫抑制治疗通过降低组织免疫功能，降低自身抗脑抗体的产生，从而减轻继发性脑损害；免疫抑制治疗将可能是一种新的颅脑创伤治疗方法。Objective To study the changes of antibrain - antibody （ABAb） in patients with traumatic brain injury and to explore the cerebral protective effects of immunosuppression therapy in rabbit - TBI - models established by lateral fluid percussion machine. Methods 96 cases （Traumatic brain injury 49 case , health adults 47 case） were phlebotomized and tested with ELISA to observe the changes of ABAb at the time points 3 d,7 d, 2w, 3w, 1 m,2 m, 6 m,9 m; 24 rabbits were separated into TBI group（ n = 8 ） ,sham operation group （ n = 8 ） ,TBI ＋ immunosuppression therapy group （ n = 8 ）. Immunosuppression therapy group was fed with CsA （ 50 mg/2 d） through the tummy duct post - TBI. 3 group rabbits were phlebotomized at the time points 2 h before injury, 3 d, 7 d,14 d, 21 d, 28 d, 35 d, 42 d, 49 d post - TBI. The blood serum specimen was tested with ELISA to observe the changes of ABAb. The expressions of Glu were examined by means of immunohistochemistry in the cerebral cortex of rabbit, meanwhile apoptosis of the neurons was determined with TUNEL. Results The concentrations of serum ABAb were significantly higher in the patients with traumatic brain injury than that in the health adults and lasted longer （ P 〈 0. 05 ）. The ABAb peak value of immunosuppression therapy group was lower than TBI group, there was significant difference in 3 groups （P 〈 0. 05 ）. Comparing with TBI group , neuronal apoptosis and expression of Glu in cortex significantly decreased in immunosuppression therapy group, there was also significant difference （ P 〈 0. 05 ）. Conclusions There was a few ABAb in the blood serum of health adults. The concentration of post - TBI ABAb was higher than nature. The concentration of the rabbit serum ABAb could be down by immunosuppression therapy, and the effect of self - attack would be alleviated consequently. We considered immunosuppression therapy will become a new therapy about TBI.

关 键 词：颅脑创伤 免疫抑制 抗脑抗体 

分 类 号：R651.15[医药卫生—外科学]