颅脑损伤患者术后血清中细胞因子与体液免疫变化的临床意义

Clinical significance of changes of serum cytokines and humoral immunity after operation in patients with craniocerebral injury

目的探讨颅脑损伤患者术后血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、C反应蛋白(CRP)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、补体C3(C3)水平的动态变化及其临床意义。方法选取北京潞河医院收治的颅脑损伤术后患者100例,分为感染组和非感染组,各50例。对患者均进行血清TNF-α、IL-6、CRP、IgG、IgM、C3水平的检测,并进行术后第1、3、7天的动态观察。结果感染组术后的第1、3天TNF-α、IL-6、CRP、IgG、IgM、C3水平高于非感染组(P<0.05),在术后第7天仅有IgG恢复至非感染组水平(P>0.05)。感染组TNF-α、IL-6、CRP水平在术后第1、3天呈现增高趋势,第7天呈下降趋势,非感染组无变化趋势;IgM、IgG、C3水平在各组间均无随时间变化的趋势。感染组IL-6水平与格拉斯哥昏迷评分(GCS)分型相关,随病情加重而显著增高(P<0.05)。结论 TNF-α、IL-6、CRP、IgG、IgM、C3水平可能在颅脑损伤术后感染的发生中有重要作用,对术后感染的早期诊断、病情严重程度的判断都有重要的辅助诊断价值。

Objective To study the dynamic changes and clinical significance of serum TNF-α,IL-6,CRP,IgG,IgM and C3 after operation in the patients with craniocerebral injury.Methods 100 postoperative patients with craniocerebral injury in Beijing Luhe Hospital were selected and divided into the infection group and the non-infection group,50 cases in each group.The levels of serum TNF-α,IL-6,CRP,IgG,IgM and C3 were detected on postoperative 1,3,7dand performed the dynamic observation.Results The levels of serum TNF-α,IL-6,CRP,IgG,IgM and C3 on postoperative 1,3din the infection group were higher than those in the non-infection group（P〈0.05）.The IgG level in the infection group was only recovered to the level of the non-infection group on postoperative 7d（P〈0.05）.The levels of TNF-α,IL-6and CRP in the infection groups showed the increasing trend on postoperative 1,3dand decreasing trend on postoperative 7d,while which in the non-infection group had no change trend;the levels of IgG,IgM and C3 in both groups had no change trend with time.The Il-6level in the infection group was related with the Glasgow Coma Score（GCS）type,which was significantly increased with the disease condition aggravation（P〈0.05）.ConclusionThe levels of TNF-α,IL-6,CRP,IgG,IgM and C3 may play an important role in the infection occurrence after operation in the patients with craniocerebral injury,and have an important auxiliary diagnostic value for the early diagnosis and judgment of disease severity of postoperative infection.