急性一氧化碳中毒后迟发性脑病患者血清和脑脊液中5-羟色胺和多巴胺的水平

Clinical significance of 5-HT and DA levels in serum and cerebrospinal fluid of the patients with delayed encephalopathy after acute carbon monoxide poisoning

目的探讨急性-氧化碳中毒后迟发性脑病（DEACMP）患者血清和脑脊液（CSF）中5-羟色胺（5-HT）、多巴胺（DA）水平的变化及其临床意义。方法用高效液相色谱法动态检测42例DEACMP患者血清和CSF中5-HT、DA水平，用日常生活能力量表（ADL）、常识记忆注意测验（IMCT）、长谷川痴呆量表（HDS）动态检查DEACMP患者的病情变化，并与38例其他脑病患者和38例非脑病患者进行比较。结果DEACMP组治疗前血清中5-HT水平[（662．61±178．50）nmol／L]、DA水平[（155．74±60．32）nmol／L明显低于非脑病组[分别为（914．08±198．04）、（225．70±48．53）nmol/L]，差异均有统计学意义（P〈0．01），治疗前血清中DA水平也明显低于其他脑病组[（243．57±66．94）nmol/L]，差异亦有统计学意义（P〈0．01），而治疗前血清中5-HT水平与其他脑病组[（729．54±299．87）nmol／L比较，差异无统计学意义（JD〉0．05）；DEACMP组治疗后血清中5-HT水平[（714．08±170．47）nmol／U、DA水平[（192．18±33．07）nmol/L]与治疗前比较均有不同程度升高，但仅有DA水平治疗前后变化的差异有统计学意义（P〈0．05）。DEACMP组治疗前CSF中5-HT水平、DA水平明显低于非脑病组及其他脑病组，差异均有统计学意义（P〈0．05）；治疗后CSF中5-HT水平[（232．44±54．28）nmol／L]恢复正常，与治疗前比较，差异有统计学意义（P〈0．01），而治疗后CSF中DA水平虽略有升高，但与治疗前比较，差异无统计学意义（p〉0．05）。DEACMP组治疗前ADL评分（50．64±7．29）、HDS评分（8．55±8．08）、IMCT评分（4．95±7．30）与治疗后（分别为35．57±16．14、16．45±10．30、15，64±10．90）比较，差异均有统计学意义（P〈0．01）。DEACMP组治疗前后血清中DA水平变化和HDS评分变化之间呈明显负相关（t=0．376，P〈0．05）。结论DEACMP患者血清和CSF中5-HT、DA水平动态变化与病情变化基本一致，动态检测5-HT、DA水平变化可作为DEACMP病情变化和治疗效果的生物学指标。

Objective To explore the changes and the clinical significance of 5-hydroxytryptamine （5-HT）, dopamine （DA） levels in serum and cerebrospinal fluid （CSF） of patients with delayed encephalopathy （DEACMP）after acute carbon monoxide poisoning. Methods The dynamic detection of 5-HT and DA levels in serum and CSF from 42 patients with DEACMP was performed with high performance liquid chromatography （HPLC）. The condition changes of patients with DEACMP were analyzed with three types of scales： the activity of daily living scale （ADL）, information memory concentration test （IMCT） and Hasegawa＇s dementia scale （HDS）; these changes were compared with those from 38 other encepbalopathy patients and 38 nonencephalopathy patients, respectively. Results Before treatment, the serum 5-HT and DA levels [（662.61± 178.50） and （155.74±60.32） nmol/L, respectively] of DEACMP group were both significantly lower than those[（914.08±198.04） and （225.70±48.53） nmol/L] of nonencephalopathy group （P〈0.05）; the serum DA level of DEACMP group was also significantly lower than that [（243.57 ±66.94） nmol/L] of other encephalopatby group （P〈0.05）; the serum 5-HT level of DEACMP group was not significantly different from that [（729.54±299.87） nmol/L] of other eneephalopathy group （P〉0.05）. After treatment, the serum 5-HT and DA levels [ （714.08±170.47 ） and （192.18±33.07 nmol/L, respectively）] of DEACMP group elevated to various extent, but only serum DA level was significantly higher than that before treatment （P〈0.05）. Before treatment, the CSF 5-HT and DA levels of DEACMP group were significantly lower than those of nonencephalopathy group and those of other encephalopathy group （P〈0.05）. After treatment, the CSF 5-HT level （232.44± 54.28 nmol/L） was similar to normal level and significantly higher than that before treatment （P〈0.05）; the CSF DA level [（56.83±12.85） nmol/L] of DEACMP group increased only slightly （P〉0.05）. In DEACMP group, ADL score （50.64±7.23）, HDS score （ 8.55±8.08 ） and IMCT score （4.95±7.30） before treatment were significantly different from those （8.5± 8.08, 4.95±7.30 and 15.64±10.90） after treatment （P〈0.01）. In DEACMP group, there was a negative correlation between DA level changes and HDS score changes, when the DA levels and HDS scores before treatment were compared with those after treatment （P〈0.05）. Conclusion The dynamic changes of 5-HT and DA levels in serum and CSF of patients with DEACMP consisted basically with the patient＇s condition change. The dynanaically detected 5-HT and DA levels can be used as the biological indicators to reflect the condition change and treatment effects of DEACMP patients.