重型颅脑损伤患者围术期脑脊液免疫球蛋白和T淋巴细胞亚群水平变化的临床意义  

Clinical significance of changes of cerebrospinal fluid immunoglobulin and T lymphocyte subpopulation levels of patients with severe craniocerebral injury in perioperative period

作　　者：李永锋 刘博 

机构地区：[1]咸阳市中心医院重症医学科,陕西咸阳712000

出　　处：《中国医学前沿杂志（电子版）》2015年第11期128-132,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨重型颅脑损伤患者围术期脑脊液免疫球蛋白和T淋巴细胞亚群水平变化的临床意义。方法选取2013年6月至2014年6月本院收治的42例重型颅脑损伤需手术患者[格拉斯哥昏迷(GCS)评分≤8分]为重型组,另选取同期30例中型颅脑损伤患者(8分<GCS≤12分)为中型组,30例轻型颅脑损伤患者(12分<GCS≤14分)为轻型组。分别采用流式细胞仪和速率散射比浊法检测三组患者围术期T淋巴细胞亚群和免疫球蛋白水平变化。统计分析重型组患者围术期GCS评分和术后格拉斯哥预后(GOS)评分变化,并分析重型颅脑损伤患者围术期脑脊液免疫球蛋白和T淋巴细胞亚群水平与其GCS评分和GOS评分的关系。结果重型组患者Ig A、Ig G、Ig M、CD3^+、CD4^+水平和CD4^+/CD8^+比值均低于中型组和轻型组(P<0.05),CD8^+水平高于中型组和轻型组(P<0.05),且重型组患者术后5、7、10天的Ig A、Ig G、Ig M、CD3^+、CD4^+水平、CD4^+/CD8^+比值、GCS评分均高于术前(P<0.05),CD8^+水平低于术前(P<0.05)。重型组、中型组、轻型组患者术后1天GCS评分均达到最低值,分别为(3.86±1.42)分、(9.61±2.87)分和(13.48±0.23)分。术后3个月重型组患者GOS评分为1、2、3、4和5分的患者比例分别为2.38%、7.14%、76.19%、9.52%和4.76%。Pearson相关性分析结果显示,重型颅脑损伤患者围术期Ig A、Ig G、Ig M、CD3^+、CD4^+水平及CD4^+/CD8^+比值与其GCS评分和GOS评分均呈正相关(P<0.05),CD8^+水平与其GCS评分和GOS评分呈负相关(P<0.05)。结论重型颅脑损伤患者围术期脑脊液Ig A、Ig G、Ig M、CD3^+、CD4^+水平及CD4^+/CD8^+比值均下降,CD8^+水平升高,且患者脑脊液免疫球蛋白和T淋巴细胞亚群水平与其GCS评分和GOS评分相关,可用于判断重型颅脑损伤患者意识程度和预测预后。Objective To investigate the clinical significance of changes of cerebrospinal fluid immunoglobulin and T lymphocyte subpopulation levels of patients with severe craniocerebral injury in perioperative period. Method 42 patients with severe craniocerebral injury（GCS ≤ 8 points） in our hospital from June 2013 to June 2014 were selected as severe group, 30 patients with moderate craniocerebral injury（8 points GCS ≤ 12 points） as moderate group and 30 patients with mild craniocerebral injury（12 points GCS ≤ 14 points） as mild group. T lymphocyte subpopulation and immunoglobulin levels in the three groups were detected by flow cytometry and rate scatter nephelometry. Analyzed the relationship between levels of immunoglobulin, T lymphocyte subpopulation and GCS score, GOS score of patients with severe traumatic brain injury in perioperative period. Result Levels of IgA, IgG, IgM, CD3~＋, CD4~＋ and CD4~＋/CD8~＋ratio of severe group were lower than moderate group and mild group, 5, 7 and 10 days after surgery, levels of IgA, IgG, IgM, CD3~＋, CD4~＋, CD4~＋/CD8~＋ ratio and GCS scores of severe group were higher than before surgery（P〈0.05）, levels of CD8~＋ was lower than before surgery（P〈0.05）. 1 day after surgery, GCS scores of severe group, moderate group and mild group, GCS score of heavy group reached the lowest value, they were（3.86±1.42） points,（9.61±2.87） points and（13.48±0.23） points respectively. 3 months after surgery, the GOS score was 1, 2, 3, 4 and 5 points of patients in severe group were respectively 2.38%, 7.14%, 76.19%, 9.52% and 4.76%. Pearson correlation analysis showed that the levels of Ig A, Ig G, Ig M, CD3~＋, CD4~＋ and CD4~＋/CD8~＋ratio in patients with severe craniocerebral injury were positively correlated with GCS score and GOS score（P〈0.05）, CD8~＋ level was negatively correlated with GCS score and GOS score（P〈0.05）. Conclusion The levels of IgA, IgG, IgM, CD3~＋, CD4~＋ and CD4~＋/CD8~＋ ratio decrease and the lev

关 键 词：重型颅脑损伤 围术期 脑脊液 免疫球蛋白 T淋巴细胞亚群 

分 类 号：R651.15[医药卫生—外科学]