亚低温对脑肿瘤患者血液和脑脊液热休克蛋白70、IL-6和TNF-α的影响

Effects of mild hypothermia on heat shock protein 70, interlukin 6 and tumor necrosis factor-α of blood and cerebrospinal fluid in patients with cerebroma

目的 观察亚低温对脑肿瘤患者血液和脑脊液热休克蛋白70（HSP70）、IL-6和TNF-α的影响,探讨低温对脑保护的分子机理.方法 选择40例脑肿瘤切除患者,按照随机数字表法分为低温组[手术中应用充气温控毯降温,维持鼻咽温度在（34.8±0.6）℃直至肿瘤切除完毕,随后进行复温]和常温组[手术中应用充气温控毯维持术中鼻咽温度在（36.6±0.4）℃],每组20例.2组患者在麻醉诱导前（TI1、打开硬脑膜后1 h（T2）以及术后24 h（T3）采集颈内静脉血和脑脊液,应用ELISA法检测HSP70、IL-6、TNF-α含量,并对结果进行统计学分析.结果 与常温组相比,低温组中心温度从手术开始至肿瘤切除完毕均明显降低,差异有统计学意义（P〈0.05）.2组血液、脑脊液HSP70随时间推移均呈上升趋势,但低温组HSP70在T2和T3时间点明显高于相应时间点的常温组,差异均有统计学意义（P〈0.05）.低温组血液、脑脊液中IL-6和TNF-α在T2和T3时间点明显低于相应时间点的常温组,差异均有统计学意义（P〈0.05）.常温组在T1、T2时间点,与血液中HSP70相比,脑脊液中HSP70含量明显较高,差异有统计学意义（P〈0.05）.结论 亚低温可增高脑肿瘤患者血液和脑脊液中HSP70的表达,降低Ⅱ-6和TNF-α的表达.脑脊液HSP70可更敏感反映脑组织损伤.

Objective To observe the effects of mild hypothermia on the heat shock protein 70 （HSP70）, interlukin 6 （IL-6） and tumor necrosis factor-α （TNF-α） in blood and cerebrospinal fluid in patients with cerebroma and explore the molecular mechanism of hypothermia on cerebral ischemia. Methods Forty patients, selected for cerebroma resection under microscopy, were randomized in normothermia group （n=20, 36.6±0.4℃） and hypothermia group （n=20, 34.8±0.6 ℃）. These temperatures were guaranteed by air temperature control blanket. Jugular venous blood and cerebrospinal fluid were collected before the anesthesia induction （T1）, 1 h after opening the endocranium （T2） and 24 h after the operation （T3）. The content of HSP70, IL-6 and TNF-α in the blood and cerebrospinal fluid was measured by EL1SA, and the results were statically analyzed. Results The core temperature in the hypothermia group was decreased significantly from starting the operation to the end of tumor resection as compared with that in the normothermia group （P〈0.05）. The level of HSP70 in blood or cerebrolspinal fluid presented an increasing trend in both groups, and the level of liSP70 at T2 and T3 in the hypothermia group was significantly higher than that in the normothermia group （P〈0.05）. Compared with those in the normothermia group, the levels of IL-6 and TNF-α in blood or cerebrospinal fluid at T2 and T3 in the hypothermia group were significantly lower （P〈0.05）. At T1 and T2 in the normothermia group, the content of HSP70 in cerebrospinal fluid was obviously higher than that in blood （P〈0.05）.Conclusion Mild hypothermia can increase the expression level of HSP70 in blood and cerebrospinal fluid and decrease the level of IL-6 and TNF-α in blood and cerebrospinal fluid. HSP70 in cerebrospinal fluid might be more sensitive than that in blood in presenting the brain injury.