亚低温对创伤性脑损伤患者脑脊液髓鞘基本蛋白的影响  

Effect of mild hypothermia on the MBP level in the CSF of TBI patients

作　　者：王剑刃[1] 傅西安[1] 吴建东[1] 肖其华[1] 钱苏荣[1] 王晨秋[1] 

机构地区：[1]江苏省苏州市卒中中心南京医科大学附属苏州医院神经外科,215008

出　　处：《中国综合临床》2012年第2期152-154,共3页Clinical Medicine of China

基　　金：基金项目：苏州市青年基金资助项目（SWKQ0820）;苏州市科技发展计划基金资助（SZD09133）;南京医科大学科技发展基金面上项目资助（09NJMUM136）

摘　　要：目的探讨亚低温对创伤性脑损伤患者脑脊液髓鞘基本蛋白（MBP）水平的影响。方法36例重型颅脑损伤患者，随机分为亚低温治疗组及常温治疗组，在不同时间点评价颅内压变化、GOS预后，通过酶联免疫吸附实验（ELISA）分析治疗各时间点脑脊液MBP的变化，综合分析亚低温对重型颅脑损伤患者的影响。结果两组比较，治疗1d脑脊液MBP浓度差异无统计学意义[分别为（24．95±2．07）、（26．72±2．43）ug／L，t=2．36，P〉0．05]。在治疗7、14d亚低温治疗组比常温治疗组脑脊液MBP浓度明显降低，差异均有统计学意义[（12．41±0．74）、（19．54±1．38）ug／L，t=19．86，P〈0．05；（7．85±0．32）、（13．51±1．46）ug／L，t=16．89，P〈0．05]。而颅内压监测显示，两组治疗1d颅内压变化差异无统计学意义，在治疗7、14d颅内压变化差异均有统计学意义[（19．0±2．1）、（26．0±2．6）mmHg，t=8．94，P〈0．05；（13．0±1．8）、（19．0±1．6）mmHg，t=10．43，P〈0．05]。两组预后比较差异有统计学意义（Z=-2．82，P〈0．05）；亚低温治疗组预后良好率明显高于常温治疗组（P〈0．05），但在病死率方面差异无统计学意义（P〉0．05）。结论亚低温治疗可能通过减少MBP降解来稳定中枢神经系统髓鞘，达到脑保护作用，从而改善重型颅脑损伤患者的预后。Objective To study the effect of mild hypothermia on MBP level in the CSF of TBI patients. Methods We investigated 36 patients with severe traumatic brain injury and randomized them into two groups,mild hypothermia treatment group and normathermia treatment group. The MBP levels in CSF and ICP and GOS scores in different time-points were evaluated. Results There was no significant difference between the two groups in the MBP level on the 1 st day after treatment （ P 〉 0.05 ）. The MBP levels in mild hypothermia group decreased greater than that in the control group on the 7th and 14th day after treatment（P 〈 0. 05）. ICP decreased more in mild hypothermia group than in the control group （ P 〈 0. 05 ） on the 7th and 14th day after treatment. Moreover, patients in mild hypothermia treatment group have better outcome than those in the control group（ P 〈 0. 05 ）, but there was no significant difference in the death rate between the two groups. Conclusion Mild hypothermia may provide neuroprotection by reducing MBP degradation and stabilizing medullary sheath, thus improving the prognosis of TB1 patients.

关 键 词：创伤性脑损伤 髓鞘基本蛋白 亚低温 脑脊液 

分 类 号：R651.15[医药卫生—外科学]