创伤性脑损伤患儿细胞活化标志物相关因素研究

The related factor research of markers of cell activation in traumatic brain injury children

目的分析评估创伤性脑损伤（TBI）患儿脑脊液（CSF）细胞活化标志物相关性。方法选取在我院儿科重症监护病房（PICU）治疗的230例TBI患）L（TBI组，n=230），以110例脑脊液未感染的非TBI患儿为对照（对照组，n=110），入院后第1天（E）与第4天（rr2）经腰椎穿刺抽取TBI患儿脑脊液，检测并比较两组患儿脑脊液中的可溶性白细胞分化抗原163（sCD163）、铁蛋白和可溶性白细胞介素-2受体（sIL-2R）水平。分析与sCD163、铁蛋白及sIL-2R相关的临床因素。结果与对照组、TBI组T1值比较，TBI组患儿在B时sCD163水平显著提高（均P〈0．05）；与对照组比较，TBI组患儿sCD163峰值显著提高（P〈0．05）。与对照组比较，TBI组患儿铁蛋白水平在T2和T1时显著提高（P〈0．05），TBI组患儿铁蛋白峰值、均值显著提高（均P〈0．05）。与对照组、TBI组T1值比较，TBI组患儿B时、均值、峰值sIL-2R水平差异无统计学意义（P〉0．05）。多元Logistic回归分析表明，铁蛋白与TBI患儿年龄≤4岁、虐待性头部外伤（AHT）、GOS评分1～3分、iGCS评分3～4分独立相关（均P〈0．05）。结论患儿低龄、人院时脑损伤较重、虐待性头部外伤、预后不良与患儿脑脊液铁蛋白升高显著相关。

Objective To evaluate related factor between cerebrospinal fluid （CSF） markers of cell activation in traumatic brain injury （TBI） children and clinical manifestations or outcomes. Methods A total of 230 TBI children （TBI group, n = 230） in pediatric of our hospital were included. One hundred and ten non-TBI children （control group, n = 110） whose cerebrospinal fluid was not infected as controls. CSF was extracted for the detection of ferritin in TBI children by lumbar puncture on the first day （T1） and the fourth day （T2） after admission. Soluble cluster of differentiation 163 （sCD163）, ferritin and soluble interleukin-2 receptor （sIL-2R） in CSF were detected and compared between the groups. The clinical factors associated with sCD163, ferritin and sIL-2R were analyzed. Results Compared with control group and TBI group at T1, sCD163 of TBI group at T2 improved significantly （all P 〈 0.05 ）. Compared with control group, sCD 163 peak improved significantly （P 〈 0.05 ）. Ferritin of TBI group at T2 and T2 improved significantly （all P 〈 0.05）. Multivariate regression revealed associations between high ferritin and age ≤4 years, COS 1 -3, abusive head trauma, and IGCS 3-4 （all P 〈 0.05 ）. Conclusion High ferritin level in CSF is significantly correlated with young age,initial injury severity, abusive head trauma, and unfavorable outcome.