弥漫性轴索损伤后CD4＋/CD8＋ T细胞比值、IL-6、IL-10水平变化及预后相关危险因素的Logistic回归分析

The changes of CD4^+/CD8^+ T lymphocyte ratio and the levels of IL-6 and IL-10 after diffuse axonal injury and Logistic regression analysis of risk factors associated with prognosis

目的研究弥漫性轴索损伤(DAI)后患者外周血CD4+/CD8+T细胞比值及炎症因子IL-6、IL-10水平的变化,探讨影响DAI患者预后的相关危险因素及可能的预测因子。方法收集115例DAI患者的相关临床资料及伤后至少6个月的随访结果,并将采集的患者外周血采用流式细胞仪检测CD4+、CD8+T细胞及其比值,ELISA法检测IL-6、IL-10水平,对免疫炎症指标及临床资料进行单因素和多因素分析,多因素分析采用Logistic回归分析。结果DAI后合并其他脑损伤、瞳孔改变、伤后昏迷时间及入院时GCS评分是影响患者预后的危险因素,而其他因素则与预后不相关。CD4+/CD8+T淋巴细胞比值降低是DAI后发生ARDS/ALI的危险因素,CD4+/CD8+T淋巴细胞比值与患者预后关系不大,而ARDS/ALI的发生则是影响DAI患者预后的重要危险因素。IL-6增加与DAI后ARDS/ALI密切相关,可作为ARDS/ALI发生的预测因子,其水平是患者预后的危险因素,而IL-10则在此过程中与ARDS/ALI不相关,且与患者预后无关。结论 CD4+/CD8+T淋巴细胞比值降低是DAI后发生ARDS/ALI的危险因素,IL-6可作为ARDS/ALI发生的预测因子。DAI后与患者预后相关的危险因素包括合并其他脑损伤、瞳孔改变、伤后昏迷时间、入院时GCS评分、IL-6水平及并发ARDS/ALI。

Objective To investigate the changes of CD4＋/CD8＋ T lymphocyte ratio and the levels of IL-6 and IL-10 in peripheral blood after diffuse axonal injury （DAI） so as to explore the risk factors affecting the prognosis of DAI patients and possible predictors. Methods A prospective study was performed by using DAI cases. The related clinical information of 115 patients with DAI and at least 6 months＇ follow-up results were recorded. The levels of CD4＋ and CD8＋ T lymphocytes in peripheral blood taken from the patients and their ratio were detected by flow cytometer. IL-6 and IL-10 levels were detected using ELISA kits. Univariate and multivariate analyses were used to analyze the immuno-inflammatory markers and clinical data. Logistic regression analysis was used in multivariate analysis. Results The complication with other brain injury, pupil changes, post-DAl coma duration and GCS score on admission were the risk factors affecting the patients＇ prognosis; other factors were not associated with the prognosis. The reduction of CD4＋/CD8＋ T lymphocyte ratio was the risk factor for ARDS/ALI after DAI, but not associated with the prognosis. The occurrence of ARDS/ALI was an important risk factor for DAI patients＇ prognosis. The increase of IL-6 was associated with the occurrence of ARDS/ALI after DAI. Its level was a predictor of ARDS/ALI occurrence in the patients and was a risk factor for prognosis. The level of IL-10 was neither associated with ARDS/ALI nor associated with the patients＇ prognosis. Oonclusiorl The reduction of CD4＋/CD8＋ T lymphocyte ratio is the risk factor for ARDS/ALI after DAI. IL-6 can be used as a predictor of ARDS/ALI occurrence. The risk factors associated with the prognosis of patients after DAI include the complication with other brain damage, pupil changes, coma duration after injury, GCS score on admission, and concurrent ARDS/AL[.