血清VEGF、Ang-1和G—CSF动态变化对急性颅脑损伤预后的影响  

Effects of dynamic changes of serum VEGF, Ang-1, and G-CSF on the prognosis of acute traumatic brain injury

作　　者：王毅[1] 田野[1] 王东[1] 孙健[1] 付胜伟[2] 刘晓勇[2] 江荣才[1] 岳树源[1] 张建宁[1] 

机构地区：[1]天津医科大学总医院神经外科,天津市神经病学研究所,300052 [2]天津医科大学总医院滨海医院神经外科

出　　处：《中华神经外科杂志》2016年第6期579-583,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（81330029,81271361）;天津市应用基础与前沿技术研究计划（15JCQNJC11300）

摘　　要：目的探讨颅脑创伤（TBI）急性期（14d内）患者血清血管内皮生长因子（VEGF）、血管生成素-1（Ang-1）和粒细胞集落刺激因子（G—CSF）的动态变化情况及其对预后的影响。方法收集2014年12月至2015年5月天津医科大学总医院神经外科和天津医科大学总医院滨海医院神经外科联合收治的符合入组条件并完成随访的54例TBI患者，分别在TBI后第1、4、7天及第14天检测血清VEGF、Ang-1和G—CSF水平，并与39例健康志愿者（对照组）比较，分析其变化情况，并据随访6个月后扩展格拉斯哥预后评分（GOSE）分为预后良好组（GOSE〉5分）和预后不良组（GOSE≤5），分析TBI急性期VEGF、Ang-1和G-CSF变化对伤者预后的影响。结果TBI急性期血清VEGF、Ang-1和G—CSF表达水平与健康对照组比较均呈升高趋势（均P〈0．05）。预后良好组TBI后第1、4、7、14天血清VEGF、Ang-1和G—CSF水平均高于预后不良组，相同时间点两组分别比较差异均有统计学意义（均P〈0．05）。多因素Logistic回归分析提示，TBI后第1天血清VEGF和G-CSF、第4天血清VEGF、Ang-1以及G—CSF、第7天血清VEGF和Ang-1水平是影响患者预后的独立风险因素（均P〈0．05）。结论VEGF、Ang-1和G-CSF在TBI急性期脑组织损伤修复和血脑屏障的修复过程中发挥了积极作用，高表达水平的血清VEGF、Ang-1和G-CSF有利于伤情的转归与结局，有可能成为判定TBI预后的重要标志物。Objective To investigate the dynamic changes of serum vascular endothelial growth factor （VEGF）, angiopoietin-1 （Ang-1） and granulocyte colony stimulating factor （G-CSF） in patients with acute traumatic brain injury （TBI） （within 14 days ） and their effects on the prognosis. Methods From December 2014 to May 2015, 54 patients with TBI met the inclusion criteria, completed the follow-up, and admitted to the Department of Neurosurgery, Tianjin Medical University General Hospital and the Department of Neurosurgery, Binhai Hospital, Tianjin Medical University General Hospital were collected. The levels of serum VEGF, Ang-1, and G-CSF were detected at day 1, 4, 7 and 14, respectively after TBI. They were compared with 39 healthy volunteers （control group） , their changes were analyzed, and they were divided into either a good outcome group （ [ Extended Glasgow outcome score ] GOSE 〉 5 ） or a poor outcome group （ GOSE ≤5） according to GOSE after 6 months follow-up. The effect of the changes of VEGF, Ang-1 and G-CSF in acute phase on TBI was analyzed. Results The expression levels of VEGF, Ang-1, and G-CSF in acute TBI showed an increasing trend compare with the healthy control group （ all P 〈 0.05）. The serum levels of VEGF, Ang-1, and G-CSF at day 1, 4, 7, and 14 of the good outcome group were higher than those of the poor outcome group. There were significant differences in the same time points between the 2 groups （ all P 〈0. 05）. Muhivariable logistic regression analysis indicated that the levels of serum VEGF and G-CSF at day 1, serum VEGF, Ang-1, and G-CSF at day 4, serum VEGF and Ang-1 at day 7 （P〈0.05） after TBI were the independent risk factors for influencing prognosis. （ all P 〈 0.05 ）. Conclusions The serum VEGF, Ang-1, and G-CSF have played a positive role in the repair of brain damage in acute phase TBI and the repair of blood-brain barrier. The high expression levels of serum VEGF, Aug-l, and G-CSF are conducive to the prognosis and outcome of t

关 键 词：颅脑损伤 血管生成因子 粒细胞集落刺激因子 前瞻性研究 预后 

分 类 号：R651.15[医药卫生—外科学]