糖皮质激素对脑外伤患者血浆肿瘤坏死因子α及白细胞介素1β的调控作用

Regulation of glucocorticoids on plasma tumor necrosis factor-α and interleukin-1β in brain trauma

目的研究糖皮质激素（glucocorticoid,GC）对脑外伤患者血浆肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）及白细胞介素1β（interleukin-1β,IL-1β）的调控作用,指导临床合理用药。方法随机选取2013年4月-2016年8月入住厦门大学附属第一医院神经外科的脑外伤患者120例,依随机表对照法随机分为激素组60例和非激素组60例,另外选择60例健康的体检者作为对照组。激素组给予常规剂量的地塞米松治疗1周。对照组不做任何处理。采用酶联免疫吸附法（ELISA）测定2组患者在治疗后第1、2、7、14天时血浆中TNF-α和IL-1β的含量。结果在第1、2天激素组的血浆中TNF-α和IL-1β的含量明显高于对照组（P〈0.05）,与非激素组差异无统计学意义。而在第7、14天明显低于非激素组（P〈0.05）,与对照组无明显差异。结论糖皮质激素对脑外伤患者TNF-α和IL-1β的调控具有明显的滞后性,损伤早期不能及时降低TNF-α和IL-1β的含量,在恢复期又使其降低,削弱了其对神经的保护作用,这可能会加剧患者的病情。

Objective To study the regulation of glucocorticoid（ GC） on plasma tumor necrosis factor-α（ TNF-α） and interleukin-1β（ IL-1β） in patients with brain trauma and guid rational drug use. Methods 120 patients with brain trauma were randomly selected from April 2013 to August 2016 in our hospital,according to a random table were divided into hormone group and non-hormonal group,60 cases of each group,another 60 healthy volunteers as control group. The hormone group received dexamethasone for one week,the control group with no treatment. The plasma TNF-α and IL-1βlevels on 1^st,2^nd,7^thand 14^ thdays were compared between two groups. Results On the 1^stand 2^ndday,plasma TNF-α and IL-1β levels in hormone group were significantly higher than control group（ P〈0. 05）,while there was no significant difference compared with non-hormone group. On 7^thand14 ^thdays,the TNF-α and IL-1β levels in hormone group were significantly lower than non-hormone group（ P〈0. 05）,while there was no significant difference compared with control group. Conclusion The regulation of GC on TNF-α and IL-1β was hysteretic in traumatic brain injury patients,and can not reduce TNF-α and IL-1β content timely,but reduce their levels during the recovery period instead,reduce their protective effects of nerve,which could exacerbate the patient＇s condition.