中重度颅脑损伤患者脑脊液中可溶性神经趋化蛋白含量的变化及临床意义

Alternation in content of soluble neural chemotactic protein in cerebral spinal in patients with moderate and severe eraniocerebral injury and its significance

目的探讨中、重度颅脑损伤患者脑脊液中可溶性神经趋化蛋白（sFkn）含量变化及与预后的相关性。方法采用前瞻性研究方法，选择本院收治的30例中、重度颅脑损伤患者，按格拉斯哥昏迷评分（GCS）分为重度组（GCS3～8分，11例）和中度组（GCS9。12分，19例）；按格拉斯哥预后评分（GOS）分为预后良好组（Ⅳ～Ⅴ级，23例）和预后不良组（Ⅰ～Ⅲ级，7例）。采用双抗体夹心酶联免疫吸附试验（ELISA）检测伤后1、3、10d患者脑脊液中sFkn含量。结果在颅脑损伤中度、重度组及预后良好和不良组，脑脊液sFkn含量均随损伤时间的延长逐渐下降，伤后10d降至最低水平，与1d和3d比较差异有统计学意义。重度组各时间点脑脊液sFkn含量（ng／L）均较中度组明显升高（1d：676．35±205．95比454．25±297．67，3d：573．11±295．38比403．90±175．04，10d：359．37±186．07比103．62±78．33，均P〈0．05）；预后不良组各时间点脑脊液sFkn含量均较预后良好组明显升高（1d：702．41±276．80比585．34±217．26，3d：697．58±164．41比431．23±220．70，10d：563．27±225．71比166．54±80．97，P〈0．05或P〈0．01）；尤以伤后10d差异较大（均P〈0．01）。结论sFkn作为前炎症因子参与了颅脑损伤的病理生理过程，脑脊液sFkn含量与颅脑损伤严重程度及患者预后密切相关，可以作为创伤后炎症反应的标志物。

Objective To explore the correlation between the changes of levels of eerebrospinal fluid （CSF） sequestered ehemokine soluble fractalkine （sFkn） and prognoses in patients with moderate and severe traumatic brain injury. Methods A prospective study was adopted, and 30 patients with moderate and severe traumatic brain injury were included in the study. According to Glasgow coma score （GCS）, the patients were divided into severe group （11 patients of GCS 3 - 8） and moderate group （19 patients of GCS 9 - 12）. According to Glasgow outcome scales （GOS）, the patients were divided into good recovery group （23 patients of grade Ⅳ～Ⅴ）and poor recovery group （7 patients of gradeⅠ～Ⅲ）. The CSF samples were collected on the 1st, 3rd, and 10th day after head injury. The concentration of sFkn in CSF was tested by enzyme-linked immunoadsorbent assay （ELISA）. Results The contents of CSF sFkn were decreased along with the gradual prolongation of time after injury in moderate, severe, poor and good recovery groups ; on lOth day after injury, the levels were decreased to the lowest in all the groups, and compared to those on the 1st and 3rd day, there were distinctive differences statistically. The CSF levels of sFkn in severe group on the 1st, 3rd, and lOth day after injury were significantly higher than those in moderate group （ 1st day ： 676.35 ± 205.95 vs. 454.25±297.67, 3rd day ： 573.11±295.38 vs. 403.90±175.04, lOth day ： 359.37±186.07 vs. 103.62±78.33, all P〈0.05）. The CSF levels of sFkn in the poor recovery group on the 1st, 3rd and lOth day after injury were significantly higher than those in good recovery group （ 1st day ： 702.41±276.80 vs. 585.34±217.26, 3rd day ： 697.58± 164.41 vs. 431.23±220.70, lOth day ： 563.27±225.71 vs. 166.54±80.97, P〈0.05 or P〈0.01）, especially on the lOth day the difference being the greatest （both P〈0.01）. Conclusions sFkn as a pro-inflammatory factor participates in pathological and pathophysiological process of head injury, and its level is closely related to the severity or prognosis of head injury, so sFkn can be a sensitive early biochemical neuromarker of inflammation after traumatic brain injury.