颅脑损伤后脑脊液C-反应蛋白与颅内压相关性及临床意义  

Correlation between the Cerebrospinal Fluid C-reactive Protein and Intracranial Pressure and Clinical Significance

作　　者：刘海峰[1] 李鹏程[1] 吴静[1] 魏风[1] 雷元华 LIU Hai-feng;LI Peng-cheng;WU ring;WEI Feng;LEI Yuan-hua(Department of Neurosurgery,Nanning First People＇ s Hospital,Fusui,Guangxi,530022 China)

机构地区：[1]南宁市第一人民医院神经外科,广西扶绥530022

出　　处：《系统医学》2018年第5期4-8,共5页Systems Medicine

摘　　要：目的探讨颅脑损伤后脑脊液C-反应蛋白与颅内压相关性及临床意义。方法选取该院于2013年2月—2016年6月期间收治的65例颅脑损伤患者,根据患者的格拉斯哥昏迷评分(Glasgow coma score,GCS)将所有患者划分为重型组、中型组和轻型组3组,其中重型组患者30例,中型组患者20例,轻型组患者15例。所有患者的脑脊液压力均采取腰椎穿刺进行检测,同时采集各组患者伤后1 d内至4周内的脑脊液。对各组患者脑脊液中的C-反应蛋白含量采用免疫比浊法进行检测,分析各组患者脑脊液中CRP水平与其颅内压变化的关系。结果各组颅脑损伤患者的颅内压水平与其脑脊液CRP水平呈正相关关系,差异有统计学意义(P<0.05),即患者的脑脊液CRP水平越高,其颅脑损伤程度越为严重,颅内压也越高。其中轻型组和中型组患者的脑脊液CRP水平会在伤后1 d内显著升高,并且在伤后3 d内分别达到峰值(0.44±0.10)、(0.72±0.47)mg/L,随后会逐渐下降,轻型组患者在1周内下降至正常水平,而中型组患者则会在2周内逐渐恢复至正常水平;重型组颅脑损伤患者的脑脊液CRP水平会在伤后6~8 h内开始显著升高,并且在3 d内达到峰值(3.44±2.66)mg/L,维持2周左右,在一个月时逐渐恢复正常。对照组脑脊液的CRP基本上检测不到,而随着颅脑损伤程度的升高,患者的CRP水平也逐渐升高。3组颅脑损伤患者伤后7 d内的每天脑脊液CRP水平和7 d均值均显著高于对照组(P<0.05),其中重型组患者7 d内每天的脑脊液CRP水平和7 d均值分别为(2.30±1.29)、(2.89±1.92)、(3.44±2.66)、(3.38±2.25)、(2.78±1.82)、(2.36±1.82)、(1.99±1.11)、(3.04±1.34)mg/L,显著高于中型组和轻型组患者,中型组患者的脑脊液CRP水平则显著高于轻型组患者(P<0.05)。结论脑脊液中的C-反应蛋白水平能够有效反映出颅脑损伤患者的颅内压变化情况,同时也是反映患者脑组织损伤的敏感指标之一。Objective To study the correlation between the cerebrospinal fluid C-reactive protein and intracranial pressure and clinical significance. Methods 65 cases of patients with cerebral injury admitted and treated in our hospital from February 2013 to June 2016 were selected and divided into the severe group, moderate group and mild group according to the GCS scores, respectively including 30 cases, 20 cases and 15 cases, and all patients used the cerebrospinal fluid pressure for lumbar puncture test, at the same time, the cerebrospinal fluid in 1 d to four weeks after injury in the three groups was collected, and the C reactive protein content was tested by the immunoturbidimetry, and the correlation between the cerebrospinal fluid C-reactive protein and intracranial pressure was analyzed. Results The cerebrospinal fluid C-reactive protein was positively correlated with the intracranial pressure in each group, and the difference was statistically significant（P〈0.05）, namely with the increase of cerebrospinal fluid CRP level, the degree of cerebral injuries were more serious, and the intracranial pressure also increased, and the cerebrospinal fluid CRP level obviously increased in 1 d after injury, and reached the peak value after 3 d,（0.44 ±0.10）L,（0.72 ±0.47）mg/L, and then gradually decreased, and the indicator in the mild group decreased to the normal level in 1 week, but the indicator gradually returned to the normal level in 2 weeks in the moderate group, and the cerebrospinal fluid CRP level of patients obviously increased in 6~8 h in the severe group, and reached the peak value in 3 d（3.44±2.66）mg/L, returning to the normal after maintaining for about two weeks, and the CRP in the control group could not be tested basically, but with the increase of degree of cerebral injuries, the CRP level of patients gradually increased, and the CRP level and average value in 7 d each day of patients after injuries in the three groups were obviously higher than those in the control group（P〈0.05）,

关 键 词：颅脑损伤 C-反应蛋白 脑脊液 颅内压 临床意义 

分 类 号：R651[医药卫生—外科学]