血清炎性细胞因子在急性脑出血并中枢性高热的表达及意义

Expression and significance of serum inflammatory cytokine in hematencephalon patients with central high fever

目的探讨血清炎性细胞因子、肿瘤坏死因子(TNF-α)及白介素6(IL-6)在脑出血(ICH)并发中枢性高热(CHF)患者的表达,以及冬眠治疗对其含量的影响。方法采用自身对照设计,用血清ELISA法检测32例ICH合并CHF患者治疗前TNF-α、IL-6水平,同时检测C反应蛋白(CRP)水平、白细胞计数(WBC)、中性粒细胞(NE)绝对值及百分率;采用物理降温结合冬眠合剂疗法,待患者体温稳定后24h复查以上指标;同时检测10例健康人的TNF-α、IL-6及CRP作为参考值。结果健康人TNF-α及IL-6参考值分别为(314.4±74.1)及(67.8±14.7)pg/ml,CRP为(31.2±7.5)μg/ml,CHF患者高热时以上三项指标显著高于参考值(均P<0.05);高热时WBC、NE绝对值及百分率显著高于参考值(P<0.05);经降温及冬眠治疗,患者体温恢复至正常且多数(84.3%)未再发CHF;治疗后TNF-α、IL-6及CRP水平显著下降(P<0.05);WBC、NE绝对值及百分率均相应明显下降(P<0.05)。相关性分析显示TNF-α、IL-6及CRP两两呈正相关性。结论 TNF-α及IL-6在CHF的发病机制扮演重要角色,冬眠治疗可能是通过减少细胞因子分泌、抑制出血灶局部及全身免疫反应而发挥治疗高热的作用。

Objective To explore the roles of serum tumor necrosis factor-α（TNF-α） and interleukin-6（IL-6） in intracerebral cerebral hemorrhage（ICH） patients with central high fever（CHF） and the effect of cockstailytic combined with physical cooling on the upper two cytokines.Methods A design of self control was performed and the serum TNF-α and IL-6 from 32 patients were detected by ELISA,so was the C-reactive protein（CRP）.Besides,another 10 health adults were accepted to detected TNF-α,IL-6 and CRP willingly for the reference value.Moreover,numeration of leukocyte（WBC）,numeration and ratio of neutrophil（NE） were also tested.Cockstailytic and physical cooling were undertaken for CHF,and the upper indexes were also observed after defervescing for 24 hours.Results The reference values of TNF-α,IL-6 and CRP were（314.4±74.1）pg/ml,（67.8±14.7）pg/ml and（31.2±7.5）μg/ml respectively,which were statistically lower than those of the onset state of CHF（all P0.05）.The numeration of WBC,neutrophil and ratio also increased significantly when CHF emerged.Treated by cockstailytic combined with physical cooling,body temperature in 32 patients turned back to normal level and most of them（84.3%） did not recrudesced.Pearson correlation analysis showed that any two of TNF-α,IL-6 and CRP presented positive relation（all P0.01）.Conclusion TNF-α and IL-6 play key roles in CHF and cockstailytic and physical cooling could downgraded this two cytokines,whose mechanism maybe that cockstailytic could hyposecrete TNF-α and IL-6,so as to inhibit the immune response of the whole body and the locality of blood dots.