纳络酮对颅脑损伤患者免疫调节的影响

Effects of naloxone on immunoregulation in patients with traumatic brain injury

目的 动态检测颅脑损伤后血液及腩脊液中体液免疫指标,分析颅脑损伤后体液免疫与疾病发展和恢复的关系,探讨纳络酮干预治疗的临床疗效.方法 前瞻性研究南海人民医院神经外科自2008年1月至12月收治的100例中重型颅脑损伤患者.按随机数字表法分为治疗组和对照组,每组50例,其中对照组仅给予常规治疗,治疗组除常规治疗外加用纳络酮治疗.伤后第4、14、21天检测患者血液和脑脊液IgG、IgA、IgM、补体C3、白蛋白（Alb）含量的变化,比较2组患者上述免疫指标、临床感染率和残疾等级评分（RDS）的差异.结果与对照组同一时间点比较.治疗组患者血液中各项免疫指标、脑脊液IgM含量差异无统计学意义（P〉0.05）,但脑脊液IgG、IgA、Alb含量,临床感染率和RDS评分均较低,差异有统计学意义（P〈0.05）;治疗组患者伤后第4天脑脊液C3阳性率（20/50）低于对照组（27/50）,差异有统计学意义（P〈0.05）.结论 脑损伤后早期应用盐酸纳络酮,可以调节免疫、促进神经功能恢复和降低感染率,从而改善患者的预后.

Objective To dynamically monitor the humoral immune parameters in the blood and cerebrospinal fluid and analyze the relationship between immunity and disease development and recovery after brain injury to explore the clinical effect of naloxone combined with mild hypothermia on the treatment of brain injury.Methods One hundred patients with severe craniocerebral injury admitted to our hospital from January 2008 to December 2008,were prospectively studied and equally divided into treatment group and control group.The control group was given conventional therapy,while the treatment group was given naloxone combined with mild hypothermia besides conventional therapy.We detected the changes of the contents of IgG,IgA,IgM,complement c3 and albumin in the blood and cerebrospinal fluid on the 4th,14th,and 21st d of injury.Then we compared the differences between the humoral immune parameters and both the clinical infection rates and the disability grades in the 2 groups.Results No statistical significance in the immune indexes of blood and the IgM content of cerebrospinal fluid was found between the control group and the treatment group （P〉0.05）,while statistical significances in the changes of the contents of IgG,IgA,IgM and albumin in the cerebrospinal fluid,the clinical infection rates and the disability grades were found between the 2 groups （P〈0.05）.The positive rate of complement c3 in the cerebrospinal fluid was statistically significant between the 2 groups on the 4th d of injury （P〈0.05）.Conclusion Naloxone combined with mild hypothermia has definite curative effect and no obvious adverse reaction in treating patients with craniocerebral injury,may resulting from the humoral regulation of naloxone.