孕酮治疗急性重型颅脑损伤疗效和作用机制的临床研究

Clinical study on the therapeutic effects and mechanism of progesterone in the treatment for acute severe head injury

目的探讨孕酮治疗急性重型颅脑损伤病人的作用机制和疗效。方法 56例急性重型颅脑损伤病人随机分成常规治疗组(n=30)和孕酮治疗组(n=26),比较两组患者急性治疗期格拉斯哥昏迷评分(GCS)和格拉斯哥预后评分(GOS)、神经功能恢复和生活质量状况(KPS)。患者入院当时、第5天和第10天,分别抽取静脉血,采用放射免疫分析法测定血清孕酮和 TNF-α,酶标放射免疫法测定15-F_(2t)-isoprostane(15-F_(2t)-IPs)。结果两组患者死亡率、急性治疗期 GCS 评分、治疗第10天 GOS 评分和语言及运动障碍程度分级评估,均无显著差异(P>0.05);治疗后3个月随访,孕酮治疗组患者 GOS 评分、语言障碍程度分级评估和远期生活质量评估,均明显优于常规治疗组(P<0.05);两组患者运动功能障碍程度分级评估无显著差异(P>0.05)。入院第5天,常规治疗组患者血清15-F_(2t)-IPs 和 TNF-α均有增高,第10天下降。与常规治疗组比较,孕酮治疗组患者入院第5、10天血清孕酮显著增高(P<0.05);血清 TNF-α和15-F_(2t)-IPs 显著减低(P<0.05)。结论应用孕酮治疗急性重型颅脑损伤,可以促进病人神经功能康复,改善预后;孕酮对急性重型颅脑损伤病人的神经保护作用与其抑制脑损伤后脂质过氧化反应和炎症反应有关。

Objective To evaluate the therapeutic effects of Progesterone（PG） on the patients with acute severe traumatic brain injury, and investigate it＇ s neuroprotective mechanisms. Methods Fifth-six patients with acute severe traumatic head injury were divided randomly into two groups ： 26 cases were treated with PG and 30 cases were control. Neurological outcome of the patients were assessed using Glasgow Coma Scale （ GCS）, Glasgow Outcome Scale （GOS）, verbal and motor functions scale and Karnofsky Performance Scale （KPS）. The serum concentrations of PG, TNF-α and 15-F2t-isoprostane were measured at day 1, 5 and 10 after trauma. Results In the two groups, There were no significant difference in the mortality, GCS of acute healing phase, GOS and verbal and motor functions at 10th days after treatment （P 〉 0. 05 ） ; After follow-up for 3 months, GOS, verbal functions and KPSin the PG treatment group were better than those in the control group （ P 〈 0. 05 ） ; In addition, there was no difference of motor functions in the two groups （ P 〉 0. 05）. At 5th day after trauma, serum 15-F2t-isoprostane and TNF-ot levels increased in the control group, but decreased at 10th day after trauma. Compared with the control group serum PG levels increased, serum 15-F2t-isoprostane and TNF-ot levels reduced significantly in the PG treatment group at 5th and 10th day after injury （ P 〈 0.05 ）. Conclusion It indicated that successive early application of PG will benefit the patients with acute severe head injury by improving the recovery and reducing the disability, which may be related to its alleviating inflammatory and lipid peroxidation response.