颅脑损伤患儿早期COR、ACTH、NLRP1及NLRP3表达与预后的相关性研究  

Correlation of early expression of COR,ACTH,NLRP1 and NLRP3 with prognosis in children with craniocerebral injury

作　　者：李永勤[1] 王涛[2] 史航宇[3] LI Yong-qin;WANG Tao;SHI Hang-yu(Department of Infectious Diseases, Xi'an Central Hospital, Xi'an 710003, China;Department of Neurosurgery, Xi'an Central Hospital, Xi'an 710003, China;Department of Pediatric Neurosurgery, Xi'an Children's Hospital, Xi'an 710043, China)

机构地区：[1]西安市中心医院感染科,西安710003 [2]西安市中心医院神经外科,西安710003 [3]西安市儿童医院小儿神经外科,西安710043

出　　处：《中国医学前沿杂志（电子版）》2017年第9期40-43,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的研究颅脑损伤患儿早期皮质醇(cortisol,COR)、促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)、核苷酸结合低聚体结构域样受体蛋白(nucleotide-binding leucine-rich repeat pyrin domain containing protein,NLRP)1及NLRP3水平与预后的相关性。方法选取西安市中心医院2013年3月至2016年3月收治的急性颅脑损伤患儿62例,依据患儿入院时格拉斯哥昏迷评分(Glasgow coma score,GCS)进行病情严重程度评估,将其分为重-特重度组(3~8分)34例和轻-中度组(9~15分)28例。另外选取同期于西安市中心医院住院治疗的非颅脑损伤患儿30例纳入对照组。记录并比较三组患儿伤后24小时血清COR、ACTH水平及伤后24小时脑脊液NLRP1和NLRP3水平,并分析其与患儿创伤严重程度及预后的相关性。结果颅脑损伤患儿的COR、ACTH及NLRP3水平均显著高于非颅脑损伤患儿(P<005);重-特重度组患儿的COR、ACTH及NLP3水平均显著高于轻-中度组患儿(P<0.05)。各组患儿的NLRP1水平均无显著差异(P>0.05)。重-特重度组患儿预后不良比例显著高于轻-中度组(P<0.05)。预后不良患儿的COR、ACTH及NLRP3水平均显著高于预后良好患儿(P<0.05),NLRP1水平组间比较无显著差异(P>0.05)。COR、ACTH及NLRP3水平与GOS呈显著负相关(P<0.05)。结论颅脑损伤患儿早期COR、ACTH及NLRP3水平均显著升高,创伤越严重,上述指标水平越高。早期COR、ACTH及NLRP3水平可以用来判断颅脑损伤的严重程度和预后,而NLRP1水平则与病情和预后关系不大。Objective To study the correlation between levels of cortisol(COR),adrenocorticotropic hormone(ACTH),nucleotide-binding leucine-rich repeat pyrin domain containing protein(NLRP)1and NLRP3and the prognosis of children with craniocerebral injury.Method62children with acute craniocerebral injury admitted in Xi'an Central Hospital from March2013to March2016were selected and divided into two groups according to the Glasgow coma score(GCS)at the time of admission:heavy-severe group(3～8points,n=34)and mild-moderate group(9～15points,n=28).30cases of children without craniocerebral injury were selected as control group in Xi'an Central Hospital during the same period.The levels of serum COR,ACTH and NLRP1,NLRP3in cerebrospinal fluid were measured at24h after injury.The levels of the above indexes were compared among the three groups to analyze the correlation between the indexes and prognosis of children with craniocerebral injury.Result The levels of COR,ACTH and NLRP3in all children with traumatic brain injury were significantly higher than non-craniocerebral injury children(P<0.05).The levels of COR,ACTH and NLP3in heavy-severe group were significantly higher than those in mild-moderate group(P<0.05).There was no significant difference in NLRP1level among the three groups(P>0.05).The proportion of poor prognosis in children with heavy-severe group was significantly higher than that in mild-moderate group(P<0.05).The levels of COR,ACTH and NLRP3in children with poor prognosis were significantly higher than those in good prognosis(P<0.05).There was no significant difference in NLRP1level among the three groups(P>0.05).COR,ACTH and NLRP3were significantly negatively correlated with GOS(P<0.05).Conclusion The levels of COR,ACTH and NLRP3are significantly increased in the early stage of craniocerebral injury,the more severe the trauma,the higher the level of the above indicators.The levels of COR,ACTH and NLRP3can be used to judge the severity and prognosis of the disease,while the level of NLRP1is not related to the co

关 键 词：皮质醇 肾上腺皮质激素 核苷酸结合低聚体结构域样受体蛋白 儿童 颅脑损伤 预后 

分 类 号：R726.5[医药卫生—儿科]