急性脑损伤患儿下丘脑促肾上腺皮质激素释放因子水平的变化

Changes of hypothalamus corticotropin releasing factor levels in children with acute brain injury

目的 探讨急性脑损伤患儿下丘脑神经元促肾上腺皮质激素释放因子（CRF）分泌水平的变化.方法 选择我院儿科监护病房51例颅内感染和11例非颅内感染脑损伤患儿为研究对象,用Glasgow评分对其脑损伤严重程度进行评估,用放射免疫法测定脑脊液中CRF水平与血清中肿瘤坏死因子（TNF）-α和白细胞介素（IL）-6水平.结果 颅内感染组和非颅内感染组患儿的Glasgow评分差异无统计学意义（P=0.302 6）,颅内感染组患儿的脑脊液中CRF浓度低于非颅内感染组（P＜0.01）,TNF-α、IL-6水平高于非颅内感染组（P＜0.01,P＜0.001）.与Glasgow评分为6～7分的患儿相比,Glasgow评分为4～5分的患儿脑脊液CRF及血清TNF-x和IL-6水平显著增加（P＜0.05,P＜0.001）.结论 颅内感染组和非颅内感染组患儿脑脊液中CRF水平是变化的,这可能与TNF-α、IL-6和低氧应激刺激脑损伤患儿下丘脑CRF神经元分泌有关.

Objective To explore the changes of corticotropin releasing factor （CRF） levels secreted by hypothalamus neuron in children with acute brain injury. Methods Fifty-one intracranial-infection children with brain injury and 11 intracranial-noninfection children with brain injury were chosen from pediatric intensive care unit of our hospital. Severities of their brain damage were evaluated by Glasgow score,and CRF level in cerebrospinal fluid （CSF） and serum TNF-α and IL-6 levels were measured by radioimmunoassay. Results There was no significant difference of Glasgow scores between the intracranial infection group and intracranial-noninfection group （ P = 0. 302 6 ）, CSF CRF level of intracranial infection group was significantly lower than that of intracranial-noninfection group （ P 〈 0. 01 ）, serum TNF-α and IL-6 levels of intracranial infection group were significantly higher than those of intracranial-noninfection group （ P 〈 0. 01,P 〈0. 001 ）. As comparing to the children with Glasgow score of 6 ～ 7, the levels of CSF CRF and serum TNF-α and IL-6 in children with Glasgow score of 4 ～ 5 were significantly increased （ P 〈 0. 05, P 〈 0. 001 ）.Conclusion CSF CRF level of the children with acute brain injury is changing, which may be concerned with the secretion of hypothalamus CRF neuron stimulated by TNF-α, IL-6 and hypoxia stress in children with brain injury.