重型颅脑损伤后早期血清IL-17、IL-23、乳酸水平变化及对继发性大面积脑梗死的预测价值  

Changes of serum IL-17,IL-23,and Lac levels in the early stage after severe head injury and their predictive value for secondary large-area cerebral infarction

作　　者：汤熠 杨自健 陈千益 蒋海云 Tang Yi;YANG Zijian;CHEN Qianyi;JIANG Haiyun(ICU,Chongming Branch of Xinhua Hospital,Shanghai 202150,China)

机构地区：[1]新华医院崇明分院综合ICU,上海202150 [2]新华医院崇明分院药剂科,上海202150

出　　处：《中国急救复苏与灾害医学杂志》2022年第1期80-84,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：上海市崇明区“可持续发展科技创新行动计划”项目(编号:CKY2020-17)。

摘　　要：目的探讨重型颅脑损伤后早期血清白细胞介素-17(IL-17)、白细胞介素-23(IL-23)、乳酸(Lac)水平变化及对继发性大面积脑梗死的预测价值。方法选取2017年9月—2020年9月新华医院崇明分院收治的158例重型颅脑损伤患者为研究组,另选同期来院体检的146例健康体检者,为对照组。比较两组血清IL-17、IL-23、Lac水平,统计研究组患者术后6个月内继发性大面积脑梗死的发生率,比较是否发生继发性大面积脑梗死患者临床特征,采用Logistic回归分析判定影响重型颅脑损伤患者发生继发性大面积脑梗死的因素,采用受试者工作曲线(ROC)分析血清IL-17、IL-23、Lac水平预测重型颅脑损伤患者发生继发性大面积脑梗死的效能。结果研究组血清IL-17、IL-23、Lac水平均高于对照组(P<0.05);发生继发性大面积脑梗死患者脑疝、蛛网膜下隙出血构成比以及血清IL-17、IL-23、Lac水平与未发生患者比较,差异均有统计学意义(P<0.05);Logistic多因素回归分析显示血清IL-17、IL-23、Lac水平及脑疝均是重型颅脑损伤患者发生继发性大面积脑梗死的独立危险因素(P<0.05);ROC分析显示,血清IL-17、IL-23、Lac水平预测重型颅脑损伤患者发生继发性大面积脑梗死的最佳截断点分别为88.28 pg/mL,55.70 pg/mL,5.26 mmol/L,灵敏度分别为86.36%,95.45%,90.91%,特异度分别为94.12%,87.50%,98.53%,曲线下面积(AUC)分别为0.942,0.951,0.979。结论重型颅脑损伤后早期血清IL-17、IL-23、Lac水平均异常升高,且发生继发性大面积脑梗死患者血清IL-17、IL-23、Lac水平均异常升高,血清IL-17、IL-23、Lac水平均可作为预测重型颅脑损伤患者发生继发性大面积脑梗死的敏感指标。Objective To explore the early changes of serum interleukin-17(interleukin-17,IL-17),interleukin-23(interleukin-23,IL-23)and lactate dehydrogenase(lactic acid,Lac)levels after severe head injury and their predic⁃tive values for secondary large-area cerebral infarction.Methods 158 patients with severe head injury were hospital⁃ized and underwent intracranial decompression via craniotomy from September 2017 to September 2020(study group).146 persons without diseases came to the hospital for physical examination during the same period(control group).Pe⁃ripheral venous blood samples were collected from the 158 patients the next day after admission and from the 146 exam⁃inees in the very days of physical examination.The levels of serum IL-17 and IL-23 were measured by automatic blood analyzer,and Lac level was measured by ELISA.Relative clinical data were collected form these 2 groups and com⁃pared between them.The incidence of secondary large-area cerebral infarction in the study group within 6 months after surgery was counted,the clinical characteristics of the patients with and without secondary large-area cerebral infarc⁃tion were compared.Logistic regression analysis was used to determine the factors affecting the occurrence of second⁃ary large-area cerebral infarction in the patients with severe head injury,and receiver operating curve(Receiver operat⁃ing curve,ROC)was used to analyze the efficacy of serum IL-17,IL-23,and Lac levels in predicting the occurrence of secondary large-area cerebral infarction in the patients with severe head injury.Results The serum levels of IL-17,IL-23,and Lac in the study group were all significantly higher than those in the control group(all P<0.05).The compo⁃sition ratio of brain herniation,subarachnoid hemorrhage and serum IL-17,IL-23,Lac levels in patients with second⁃ary large-area cerebral infarction compared with those without patients,the difference were statistically significant(P<0.05).Logistic multivariate regression analysis showed that the serum IL

关 键 词：重型颅脑损伤 白细胞介素-17 白细胞介素-23 乳酸 继发性大面积脑梗死 

分 类 号：R657.51[医药卫生—外科学]