高血压性脑出血患者不同体液TNF-α水平动态变化及意义

Dynamic changes and significance of TNF-α in patients with hypertensive intracerebral hemorrhage

目的探讨高血压性脑出血患者血清、脑脊液、血肿液中TNF-α水平及在不同治疗方式下的动态变化。方法采用放射免疫法检测67例高血压性脑出血患者(分为微创术组和内科组)出血后24h及治疗后72h、7d、14d血清、脑脊液、血肿液中TNF-α含量,并评定以上各时段NIHSS评分。结果高血压性脑出血患者血清TNF-α水平明显升高,经钻颅微创颅内血肿碎吸术治疗72h血清TNF-α水平明显高于内科治疗组(P<0.05),微创术组在术后30min及72h脑脊液TNF-α水平均明显高于内科治疗组(P<0.01),7d后2组差异无统计学意义(P>0.05)。各时段血清TNF-α水平均与NIHSS评分呈正相关(P<0.01)。不同时段三种体液中TNF-α水平比较显示,72h三种体液中均达到高峰,随后逐渐降低,脑脊液及血肿液浓度均高于血清。结论高血压性脑出血患者血清TNF-α水平升高,并随病程进展动态变化,与症状严重程度相关,该因子有可能参与脑出血后神经功能损伤的一系列病理生理过程。

Objective To investigate the level of TNF-a in serum, cerebrospinal fluid and hematoma fluid of hypertensive intracerehral hemorrhage and the dynamic change after the different treatment. Methods Totally 67 patients with hypertensive intracerebral hemorrhage were divided into two groups, minimally invasive surgery group and medicine group, the radioimmu- noassay was used to measured the TNF-a in serum, cerehrospinal fluid and hematoma fluid in 24 hours after bleeding, then the same measurements were used to 72 hours, 7 days and 14 days after two treatment methods respectively. NIHSS was used to assess the symptoms in the above periods with patients. Results The levels of TNF-~ were significantly increased in serum with hypertensive intracerehral hemorrhage. The serum TNF-a level in minimally invasive surgery group was significantly high- er than that in medicine group after 72 hours （P〈0.05）. TNF-a in cerebrospinal fluid of minimally invasive surgery group was significantly higher than that in medicine group after 30 minutes （P〈0.0l） and 72 hours （P〈0.0l）. There were no signifi- cant difference after 7 days（P〉0.05）. The serum TNF-a levels were significant positive correlation with NIHSS scores in ev- ery periods （P〈0.01）. In every period of three fluids, the TNF-a level reached the peak in 72 hours. Then gradually de- creased, the TNF-a levels in cerebrospinal fluid and hematoma fluid were higher than that in serum. Conclusion The TNF-a level of patients with hypertensive intracerebral hemorrhage was higher than normal, it changes with the progression dynami- cally, and related with the severity of the symptoms. It＇s suggested that the TNF-a may be involved into a series of pathophysi- ological process after hypertensive intracerehral hemorrhage.