高压氧对颅脑损伤患者血清巨噬细胞移动抑制因子和脂肪炎症因子的影响

Effects of hyperbaric oxygen on serum macrophage migration-inhibitory factor and Apelin in patientswith severe cranioeerebral injury

目的探讨重型颅脑损伤患者高压氧（hyperbaric oxygen，HBO）治疗前后，外周血巨噬细胞移动抑制因子（MIF）和脂肪炎症因子（Apelin）的水平变化及其与HBO治疗效果及预后的关系。方法选择2010年3月至2011年3月由我院神经外科确诊并收治的120例颅脑损伤患者，经患者知情同意，并签署知情同意书后随机分为HBO组和常规治疗组，每组60例。HBO组行HBO±常规治疗，常规治疗组仅单纯常规治疗。选择60名健康体检者为正常对照组。3组分别于治疗前用哥拉斯哥评分（Glasgow coma scale，GCS）对患者进行评定，采用酶联免疫（ELISA）法检测血清M1F和Apelin含量。结果HBO组和常规治疗组治疗前MIF和Apelin差异无统计学意义（t=1．05、、1．02，P均〉0．05），但与正常对照组比较差异均有统计学意义（MIF：t=16．23、16．14；Apelin：17．48、17．53；均P〈0．01）。治疗1个疗程后，HBO组[（17．73±2．25）μg/L、（112．72±20．35）ng／L]和常规治疗组[（26．17±2．38）μg／L、（182．14±21．47）ng／L]MIF和Apelin水平均比治疗前[HBO组：（32．63±2．79）μg／L、（246．65±29．62）ng／L；常规治疗组：（32．42±2．81）μg/L、（246．65±29．62）ng／L]有所下降（MIF：t=12．49、8．63，Apelin：12．73、8．24，；均P〈0．05）；治疗3个疗程后，HBO组的MIF和Apelin水平逐渐接近正常对照组（t=1．18、1．23，均P〉0．05），而常规治疗组MIF和Apelin水平均高于HBO组和正常对照组（MIF：t=8．23、8．39，Apelin：8．21，8．37；均P〈0．05）。结论HBO能影响颅脑损伤患者MIF和Apelin水平，提示检测患者外周血MIF和Apelin含量，可作为观察HBO治疗效果的辅助指标。

Objective To study changes in serum macrophage migration-inhibitory factor （MIF） and Apelin and the relationship between hyperbaric oxygen （HBO） and its prognosis, following pre and post HBO therapy of patients with severe craniocerebral injury. Methods One hundred and twenty patients were chosen as subjects diagnosed and admitted into the Neurosurgical Department of our hospital from March 2010 to March 2011. With the knowledge and consent of the patients and following the signing of the letter of agreement, the patients were divided into the HBO group and the routine treatment group, each consisting of 60 patients. The HBO group was given HBO therapy ± routine treatment, while the routine treatment group was only given routine treatment, and another 60 people who had routine physical cheek-ups served as the control group. The patients were assessed with Glasgow Outcome Scale （GOS） both before and after treatment. Levels of MIF and Apelin in the serum were detected with ELISA. Results No statistical significance could be noticed in the serum levels of MIF and Apelin detected both before and after treatment, when comparisons were made between the HBO group and the routine treatment group （ t = 1.05, 1.02 ; P 〉 0. 05）. However, statistical significance could be noted, when compared with the control group （ MIF： t = 16.23, 16.14 ; Apelin： t = 17.48,17.53） （P 〈 0. 01 ）. After one course of treatment, levels of MIF and Apelin for the HBO group[ （17.73 ±2.25）μg/L,（112.72 ±20.35） ng/L] and the routine treatment group [ （26.17 ±2.38） μg/L, （ 182.14 ± 21.47 ） ng/L] were all lower than those before treatment [ HBO group： （ 32.63 ± 2.79 ） μg/L, （ 246.65 ± 29.62 ） ng/L ; the routine treatment group ： （ 32.42 ± 2.81 ） μg/L, （ 246.65 ± 29.62 ） ng/L 1 （ MIF ： t = 12.49, 8.63 ; Apelin ： t = 12.73,8.24, P 〈 0.05 ）. After 3 courses of treatment, levels of MIF and Apelin gradually approached the normal values of the normal control group （t = 1.18,1.23 ） （P 〉 0.05 ） , while the levels of MIF and Apelin for the routine treatment group were all higher than those of the control group（ MIF：t = 8.23,8.39; Apelin： t=8.21, 8.37）（P〈0.05）. Coneluslons HBO seemed to affect the serum levels of MIF and Apelin in patients with severe cranioeerebral injury, indicating that the levels of MIF and Apelin detected in the peripheral blood might serve as important adjuvant markers for the observation on the effect of HBO therapy.