重型颅脑创伤病人CSF中IL-6含量的变化及其临床意义

Clinical significance and change in IL-6 concentration in CSF in patients with acute severe traumatic brain injury

目的研究急性重型颅脑创伤(sTBI)病人脑脊液(CSF)中白细胞介素-6(IL-6)含量的变化及亚低温治疗对其影响与临床意义。方法80例急性sTBI患者(伤后6h内入院,GCS≤8分)随机分为亚低温(HT)组和常温(NT)组各40例,采用放射免疫法检测亚低温治疗前(伤后早期)、后不同时段CSF中IL-6的含量,同时对比两组病人的颅内压(ICP)、GlasgowOutcomeScale(GOS)计分指标并分析其间关系。结果急性sTBI病人伤后早期CSF中IL-6含量明显增高。与NT组病人比较,亚低温治疗后24h,HT组病人的ICP值和IL-6含量明显降低(P<0.05;P<0.05),并持续至复温后24h(P<0.01;P<0.01),而IL-6含量在伤后1个月时仍明显低于NT组(P<0.01)。HT组病人伤后6个月时的GOS计分明显高于NT组(P<0.05),即HT组病人的预后较好。结论sTBI病人急性期CSF中IL-6含量增高,亚低温可降低急性sTBI后的高ICP和明显抑制IL-6超表达,改善临床预后。

Objectives To investigate changes of Interleukin-6(IL-6)concentration of cerebrospinal fluid (CSF) in patients with acute severe traumatic brain injury(sTBI), the effect of moderate hypothermic therapy on IL-6 and clinical significance. Methods 80 patients with acute severe traumatic brain injury were randomly divided into hypothermic therapy(HT)group and normothermic therapy(NT)groups. Inclusion criteria included Glasgow coma Scale (GCS) score, was no more than 8 and the patient was admitted within 6 hours after injury, no other organs injury and functional failure. We recorded the GCS score on admission, the level of ICP before and during the treatment, GOS score 6 months after injury. CSF samples which were collected at different time before , during and after hypothermic therapy using ventricular external tube and lumber puncture were analyzed for IL-6 concentration changes by radioimmunoassay. Results The IL-6 levels were all over-high and there was not any significant difference between two groups in early phase after injury(before moderate hypothermic therapy)(P >0.05). In comparison with NT group, at the 24 hour of the moderate hypothermia, the ICP level and IL-6 concentration of HT group were significant lower(P<0.05;P<0.05), sustained at those lower levels until 24 hours after rewarming(P<0.01;P<0.01), and IL-6 concentration of HT group was always significant lower one month after rewarming period(P<0.01). The GOS scores were significantly higher 6 months after sTBI(P<0.05),which was better outcome in HT group than NT group. Conclusions Early and excessive expression of IL-6 after sTBI, the moderate hypothermic therapy can decrease the level of the increased ICP and significantly suppress the over-expression of IL-6, improve prognosis in patients with acute sTBI.