高渗盐水对重症脑出血的免疫调节作用研究

Study on immunomodulatory effects of hypertonic saline for severe intracerebral hemorrhage

目的探讨10%高渗盐水对重症脑出血患者的外周血细胞计数及单核细胞亚群分布的影响。方法将首都医科大学附属北京天坛医院急诊科2012年4月-2013年4月收治的重症脑出血伴有中线移位患者共24例,随机分为高渗盐水治疗组（HS组）12例和甘露醇治疗组（MT组）12例。HS组给予10%氯化钠溶液50 mL静脉点滴,30 min输完;MT组给予20%甘露醇250 mL静脉点滴,15-20 min内输完。脱水治疗开始后0、1、3、6、24 h静脉采集外周血,进行全血细胞计数,及流式细胞仪测定血单核细胞CD16、CD14表达水平,两组患者血细胞计数值以均数±标准差（x±s）表示,组间比较使用两独立样本t检验,两组单核细胞亚群表达水平为频数资料,组间比较使用χ^2检验。采用SPSS 13.0统计软件处理数据,以P〈0.05为差异有统计学意义。结果由于应激反应,两组患者基线的白细胞计数均增高,脱水后两组白细胞总数和中性粒细胞计数均有降低,6 h最为明显,差异有统计学意义（P〈0.05）,24 h较前有所回升,但组间差异无统计学意义（P〉0.05）;与基线比较,脱水后MT组淋巴细胞计数降低,3、6 h最为明显,差异有统计学意义（P〈0.05）,而HS组无明显淋巴细胞减少,组间3、6 h差异有统计学意义（P〈0.05）。脱水治疗后,外周血单核细胞亚群出现重新分布。MT组CD14^＋＋细胞显著下降,CD14^＋＋CD16^＋表达显著增加,而在HS组,CD14^＋＋细胞呈中度增加,CD14^＋＋CD16^＋亚群表达却显著减少,组间比较差异有统计学意义（P〈0.05）。结论急性重症脑出血患者应用高渗盐水脱水治疗可促进淋巴细胞增殖,减少前炎症单核细胞CD14^＋＋CD16^＋亚群表达,减轻炎症反应,调节卒中后的免疫失衡。

Objective To investigate the effect of 10% hypertonic saline（HS） on peripheral blood cells count and distribution of monocytes subpopulations of patients with severe intracerebral hemorrhage. Methods Twenty-four patients with severe intracerebral hemorrhage and midline shift admitted to Department of Emergency, Beijing Tiantan Hospital, Capital Medical University from April 2012 to April 2013 were randomly divided into： HS group（n = 12） and mannitol（MT） group（n = 12）. Patients in HS group received intravenous administration of 50 mL of 10% sodium chloride within 30 min; MT group received 250 mL of 20% mannitol within 15-20 min. Peripheral blood samples were collected before dehydration treatment, and at 1, 3, 6, 24 h after dehydration treatment, then the samples were measured for blood cell count and monocytes subpopulations including CD16, CD14 were detected by flow cytometer. Data of blood cell count were expressed as mean±standard（x±s）, the inter-group comparison was carried out by independent sample ttest. The level of monocytes subpopulations was frequency date, the inter-group comparison was carried out by χ^2test.SPSS 13.0 software was used for statistical analysis, P〈0.05 was taken as a statistically significant difference. Results The hemorrhage stroke induced a significant leukocytosis in all patients as evidenced by elevating baseline cell counts.After dehydration, the total leukocyte and neutrophil counts in the two groups were all decreased, especially at 6 h, the difference was statistically significant（P〈0.05）, they rose again at 24 h, while there were no significant differences in cell counts between the two groups（P〉0.05）. Compared with the baseline, the lymphocyte count of MT group after dehydration was reduced, especially at 3, 6 h, the difference was statistically significant（P〈0.05）, while HS group showed no significant reduction of lymphocyte count,there were statistically significant differences of lymphocyte count after dehydration for 3, 6 h between the two groups（P〈0.05）. After dehydration, peripheral blood monocyte subsets showed redistribution. Cells of CD14^＋＋in MT group was reduced and the expression of CD14^＋＋CD16^＋was increased, while in HS group, cells of CD14^＋＋was moderately increased, and the expression of CD14^＋＋CD16^＋was reduced, there were significant differences between the two groups（P〈0.05）. Conclusion Application of HS for dehydration treatment in patients with acute severe intracerebral hemorrhage can promote lymphopoiesis, inhibit the expression of ＂pro-inflammatory＂ CD14^＋＋CD16^＋subsets, reduce the inflammatory response and adjust the immune imbalance after stroke.