神经生长因子和双肾上腺皮质激素表达与儿童重型创伤性颅脑损伤预后的相关性

Nerve growth factor and doublecortin expression correlates with improved outcome in children with severe traumatic brain injury

目的探讨神经生长因子(NGF)和双肾上腺皮质激素(DCX)与重型创伤性颅脑损伤患儿预后的相关性。方法 12例重型颅脑损伤患儿设为试验组,另纳入12例为排除脑膜炎进行腰椎穿刺的患儿设为对照组。脑损伤后2 h(T1)、48 h(T2)收集患儿脑脊液,采用双位酶免疫法测定NGF浓度,免疫印迹法分析DCX表达水平。治疗后6个月末使用格拉斯哥预后评分(GOS)对试验组患儿进行疗效评估,分析NGF、DCX与预后的关系。结果试验组T1时NGF水平明显高于对照组(P<0.01),T2时与T1时相比有显著增高(P<0.05)。T1时预后好与差的患儿NGF水平无显著差异(P>0.05),T2时预后好的患儿NGF水平高于预后差的患儿[(414.93±135.51)pg·mL^(-1)vs.(186.72±104.18)pg·mL^(-1),P<0.05]。对照组DCX表达始终保持在基础水平,试验组T1时预后好和预后差的患儿DCX水平无显著差异(P>0.05),T2时DCX水平分别为(2.25±0.41)ng·mL^(-1)和(0.11±0.04)ng·mL^(-1),有显著差异(P<0.05)。NGF和DCX之间有显著相关性,相关系数为0.76(P<0.05)。结论创伤性早期NGF和DCX上调的重度脑损伤患儿有较好的临床治疗效果,提示NGF和DCX有助于改善重型颅脑损伤的预后。

AIM To investigate the relationship of nerve growth factor （NGF） and doublecortin （DCX） with prognosis in children with severe traumatic brain injury. METHODS Twelve patients with severe craniocerebral injury were enrolled in experimental group, and 12 patients with suspected meningitis were enrolled in control group. Cerebrospinal fluid was collected at 2 h （T1） and 48 h （T2） after brain damage to detect the levels of NGF and DCX by two-site enzyme immunoassay and western blot analysis, respectively. The clinical outcome was evaluated by Glasgow outcome score （GOS） in the experimental group after 6 months treatment. The relationships between NGF levels, DCX levels and the response to therapy were analyzed.RESULTS The levels of NGF at T1 were significantly higher in experimental group than that in control group （P 〈 0.01 ） , and further increased at T2 in the experimental group （P 〈 0.05）. There was no correlation between NGF levels and clinical outcome at T1 （P 〉 0.05） , however, NGF levels in children with good outcome was higher than that in children with poor outcome at T2 （（414.93±135.51） pg·mL^-1 vs. （186.72 ± 104.18） pg·mL^-1, P 〈 0.05）. The DCX expression remained at baseline in the control group. The DCX levels in children with good outcome was comparable to that in children with poor outcome at T1 （P 〉 0.05） , but significantly higher at T2 （（2.25 ± 0.41） ng·mL^-1 vs. （0.11 ±0.04） ng·mL^-1, P 〈 0.05）. There was a significant correlation between NGF levels and DCX levels in the experimental group and the correlation coefficient was 0.76 （P 〈 0.05）. CONCLUSION Children with up-regulated NGF and DCX at early traumatic brain injury have a better prognosis, suggesting that NGF and DCX may contribute to the improvement of severe craniocerebral injury.