非对称性二甲基精氨酸在急性脊髓损伤患者治疗前后的变化

Changes and significance of ADMA before and after regimen of treatment proposed by NASCIS- Ⅲ in patients with ASCI

目的探讨ASCI〈8h患者早期按照NASCIS-IH方案治疗前后，血清ADMA、致炎性细胞因子（TNF-α，IL-6）及NO的变化及意义。方法高效液相色谱法（HPLC）测定血清中ADMA的水平，酶联免疫吸附ELISA法检测TNF-α，IL-6，NO血清水平，并以健康体检人员作对照；以Frankel标准进行分级，观察治疗前其与ADMA的水平的关系，并评估疗效。结果观察组较之对照组，血清ADMA与致炎性细胞因子水平呈正相关（TNF-α：r=0．59；IL-6：r=0．51P〈0．05）的增高，NO水平降低（P〈0．05），Frankel分级随ADMA水平升高而升高，治疗后，血清ADMA及TNF-α，IL-6水平降低，NO水平增高（P〈0．05），神经功能改善，且有并发症组治疗前的ADMA水平高于无并发症组（P〈0．05）。结论早期致炎性细胞因子促进ADMA调节的NO血管途径可能参与了ASCI的病理过程，且可能是NASCIS-Ⅲ方案治疗的病理生理学基础并有望成为ASCI的评估指标。

Objective To investigate the changes and significance of asymmetric dimethyl argilline （ADMA）, the pro-inflammatory cytokines （TNF-α, IL-6） and NO levels before and after treatment regimen proposed by National Acute Spinal Cord Injury Studies Ⅲ （ NASCIS- Ⅲ ） in patients with acute spinal cord injury （ASCI）. Method Plasma ADMA was measured by using HPLC methods. TNF-α, IL-6 and NO were measured by using ELISA. And 30 healthy subjects from the department of physical examination were enrolled as normal controls. Therapeutic effects of the treatment were evaluated by using Frankel method. Results Compared with the healthy subject, ADMA levels of patients were markedly elevated with close correlation with the levels of the pro-inflammatory cytokines （TNF-α： r = 0.59; IL- 6： r = 0.51, both P 〈 0.05）, and the NO levels of patients were markedly decreased, and the higher values of Frankel score the higher ADMA levels. After treatment, ADMA, TNF-α and IL-6 levels were markedly decreased, and NO levels were elevated with Frankel scores lowered. Those patients with complications had higher ADMA levels. Conclusions In the early stage, the pro-inflammatory cytokines enhance ADMA for regulating NO metabolism which might play a pivotal role in ASCI, and maybe the pathophysiological rationale of the NASCI- Ⅱ proposal. The ADMA is likely to be a valuable biomarker in patients with ASCI.