田达+刘宏+李湖广

[摘要] 目的 探讨IL-1β、IL-6 与颅脑损伤（TBI）程度的关系及临床意义。 方法 2010年1月～2012年12月我院收治的TBI患者231例，于伤后1 d、3 d、7 d、10 d检测血清及脑脊液（CSF）中 IL-1β 及 IL-6 水平。根据格拉斯哥昏迷量表评估损伤程度，将患者分为轻型组72例、中型组84例、重型组75例，比较三组IL-1β 及 IL-6 水平。伤后6个月，根据格拉斯哥预后量表评估显示，死亡28例、植物生存3例、重残25例、中残31例、恢复良好144例。比较不同预后患者IL-1β及IL-6水平。 结果 轻型组及中型组IL-1β、IL-6水平无明显差异，但两者均低于重型组（P<0.05）。死亡、植物生存患者IL-1β、IL-6水平无明显差异，但两者均高于重残患者（P<0.05）。死亡、植物生存及重残患者IL-1β、IL-6水平均高于中残及预后良好患者（P<0.05）。 结论 血清及脑脊液中IL-1β、IL-6水平与TBI损伤程度及预后密切相关。

[关键词] 颅脑损伤；血清；脑脊液；炎性因子

[中图分类号] R651 [文献标识码] A [文章编号] 1673-9701（2015）25-0008-05

The relationship between IL-1β， IL-6 in serum and cerebro-spinal fluid and severity of traumatic brain injury

TIAN Da1 LIU Hong2 LI Huguang1

1.Department of Neurosurgery， Lishui Peoples Hospital in Zhejiang Province， Lishui 323000， China； 2.Emergency ICU， Lishui Peoples Hospital in Zhejiang Province， Lishui 323000， China

[Abstract] Objective To investigate the relationship of interleukin （IL）-1β and IL-6 levels of patients with the severity of traumatic brain injury（TBI） and their clinical significance. Methods A total of 231 patients with TBI admitted to our hospital from Jan 2010 to Dec 2012 were measured the levels of IL-1β and IL-6 in serum and cerebro-spinal fluid. All the patients were divided into mild injury group（72 cases），moderate injury group （84 cases），severe injury group （75 cases） according to the Glasgow coma scale， levels of IL-1β and IL-6 of the three groups were compared. They were divided into different groups according to the prognosis evaluated by Glasgow coma scale after treatment 6 months， death 28 cases， vegetable survival 3 cases， severe disability 25 cases， moderate disability 31 cases， good recovery 144 cases， IL-1β and IL-6 of patients with different prognosis were compared. Results IL-1β and IL-6 levels were significantly increased in mild injury group，moderate injury group，severe injury group compared with control group（P<0.05）. IL-1β and IL-6 in mild injury group，moderate injury group were lower than those in severe injury group（P<0.05）. There was no significantly difference in IL-1β and IL-6 between mild injury group and moderate injury group（P>0.05）. IL-1β and IL-6 of the death and vegetable survival were higher than those of severe disability. IL-lβ and IL-6 of death， vegetable survival， and severe disability were higher than those of moderate disability and good recovery（P<0.05）. Conclusion The levels of IL-1β and IL-6 in serum and CSF are closely related to the severity of TBI and can be used as clinical monitoring indices.

[Key words] Traumatic brain injury； Serum； Cerebrospinal fluid； Proinflammatory cytokine

颅脑损伤（TBI）是临床常见的危重急症，死亡率较高。近年研究发现，TBI所发生的脑组织损伤及死亡大部分是继发性炎性反应引起的[1，2]。炎症因子与颅脑损伤后的炎症反应启动和调节有密切关系，是颅脑损伤病理生理过程中的一个重要构成因素[3，4]。随着损伤发生时血脑屏障的破坏，单核细胞、巨噬细胞和中性粒细胞等外周血炎性细胞浸润到脑实质内，使IL-1β和IL-6合成增加[5，6]。炎性因子过度表达导致严重炎症，对患者造成不良影响。本文通过检测我院近年收治的急性颅脑损伤患者血清及脑脊液中IL-1β及 IL-6 水平，探讨其与患者损伤程度及预后的关系，现报道如下。

1 资料与方法

1.1 一般资料

2010年1月～2012年12月我院收治的急性颅脑外伤患者231例。纳入标准：①伤后12 h内入院治疗；②经头部CT确诊为颅脑外伤；③无其他部位严重合并伤。排除标准：①治疗未超过24 h死亡或出院；②近期接受过化疗（6个月内）或皮质激素治疗（3个月内）；……