重型颅脑创伤急性期和慢性期外周血炎症反应标志物和氧化应激临床研究  

Clinical study on the changes of peripheral inflammatory markers and oxidative stress during post-acute and chronic phase after severe traumatic brain injury

作　　者：李峰 田冰锋[2] 魏小兵[2] 冯波[2] 张春满[3] 肖伟 LI Feng1, TIAN Bing-feng2, WEI Xiao-bing2, FENG Bo2, ZHANG Chun-man3, XIAO Wei4(1Department of Neurosurgery, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang 712000, Shaanxi, China 2Department of Neurosurgery, Hanzhong Central Hospital, Hanzhong 723000, Shaanxi, China 3Department of Neurosurgery, Yah＇an University Affiliated Hospital, Yan ＇an 716000, Shaanxi, China 4Department of Neurosurgery, Jingbian County People＇s Hospital, Yulin 718599, Shaanxi, China)

机构地区：[1]陕西省核工业二一五医院神经外科,咸阳712000 [2]陕西省汉中市中心医院神经外科,723000 [3]延安大学附属医院神经外科,716000 [4]陕西省榆林市靖边县人民医院神经外科,718599

出　　处：《中国现代神经疾病杂志》2018年第2期128-133,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的探讨重型颅脑创伤急性期和慢性期外周血炎症反应标志物和氧化应激参数表达变化。方法共24例重型颅脑创伤患者测定炎症反应标志物[包括白细胞介素(IL)-1β、IL-6、干扰素-γ(IFN-γ)和肿瘤坏死因子-α(TNF-α)]和氧化应激参数[包括谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽还原酶(GR)和总血浆抗氧化剂活性(TEAA)]水平,采用功能独立性评价(FIM)和运动障碍评价量表(DRS)评价认知功能和运动功能。结果颅脑创伤患者不同时期(后急性期、慢性期早期、慢性期)IL-6(F=105.982,P=0.000)、IFN-γ(F=19.873,P=0.000)、GSH-Px(F=162.090,P=0.000)、SOD(F=28.254,P=0.000)和CAT(F=4.782,P=0.011)水平差异有统计学意义,其中,IL-6和GSH-Px水平慢性期早期(IL-6:t=11.753,P=0.000;GSH-Px:t=16.901,P=0.000)和慢性期(IL-6:t=14.533,P=0.000;GSH-Px:t=13.828,P=0.000)均低于后急性期,慢性期亦低于慢性期早期(IL-6:t=2.341,P=0.012;GSH-Px:t=3.073,P=0.003);SOD水平慢性期早期和慢性期高于后急性期(t=7.264,P=0.000;t=5.308,P=0.000);CAT水平仅慢性期早期高于后急性期(t=3.060,P=0.003)。与随访初期相比,随访结束时FIM评分升高(t=36.260,P=0.000)、DRS评分降低(t=49.010,P=0.000)。Pearson相关分析显示,IL-6(r=0.446,P=0.020)和GSH-Px(r=0.142,P=0.000)表达变化与全部认知功能指数呈正相关,IL-6与认知功能综合指数之注意力(r=0.431,P=0.026)和执行功能(r=0.522,P=0.005)呈正相关,IFN-γ(r=0.497,P=0.009)和TNF-α(r=0.479,P=0.009)仅与认知功能综合指数之执行功能呈正相关,GSH-Px与认知功能综合指数均呈正相关(r=0.220,P=0.000;r=0.344,P=0.000;r=0.011,P=0.000)。结论重型颅脑创伤患者急性期氧化应激平衡改变和炎症反应标志物过表达不利于功能恢复,测定炎症反应标志物和氧化应激参数表达变化,可以为重型颅脑创伤患者功能评价和预后预测提供一定依据。ObjectiveTo explore the clinical changes of peripheral inflammatory markers and oxidative stress during post-acute and chronic phase after severe traumatic brain injury（s TBI）.Methods A total of 24 s TBI patients were included in this study.The changes of peripheral inflammatory markers[interleukin（IL）-1β,IL-6,interferon-γ（IFN-γ）and tumor necrosis factor-α（TNF-α）]and oxidative stress parameters[glutathione peroxidase（GSH-Px）,superoxide dismutase（SOD）,catalase（CAT）,glutathione reductase（GR）and total plasma antioxidant activity（TEAA）]were monitored.Functional Independence Measure（FIM）and Dyskinesia Rating Scale（DRS）were used to evaluate cognitive function and motor function.Results There were significant differences on IL-6（F=105.982,P=0.000）,IFN-γ（F=19.873,P=0.000）,GSH-Px（F=162.090,P=0.000）,SOD（F=28.254,P=0.000）and CAT（F=4.782,P=0.011）during different periods of s TBI（post-acute phase,chronic early phase,chronic phase）.IL-6 and GSH-Px in chronic early phase（IL-6：t=11.753,P=0.000;GSH-Px：t=16.901,P=0.000）and chronic phase（IL-6：t=14.533,P=0.000;GSH-Px：t=13.828,P=0.000）were significantly lower than post-acute phase.IL-6and GSH-Px in chronic phase（IL-6：t=2.341,P=0.012;GSH-Px：t=3.073,P=0.003）were significantly lower than chronic early phase.SOD in chronic early phase and chronic phase was significantly higher than post-acute phase（t=7.264,P=0.000;t=5.303,P=0.000）.CAT in chronic early phase was significantly higher than post-acute phase（t=3.060,P=0.003）.After 12 months,24 patients completed the follow-up,and their FIM scores were significantly increased（t=36.260,P=0.000）,while DRS scores were significantly decreased（t=49.010,P=0.000）.Pearson correlation analysis showed that IL-6（r=0.446,P=0.020）and GSH-Px（r=0.142,P=0.000）were positively correlated with overall cognitive performance index（CPI）.IL-6 was positively correlated with attention（r=0.431,P=0.026）and executive function（r=0.522,P=0.005

关 键 词：脑损伤 肿瘤坏死因子Α 氧化性应激 

分 类 号：R651.15[医药卫生—外科学]