脑外伤患者血清炎症细胞因子与颅内压关系的研究

Relationship between inflammatory cytokines and intracranial pressure in patients with traumatic brain injury

目的研究重型脑外伤手术患者血清炎症细胞因子与颅内压(ICP)之间的关系。方法 32例重型脑外伤患者均于术中放置ICP探头,术前及术后每12小时采集血清并测定白细胞介素1β(IL-1β)、白细胞介素8(IL-8)及肿瘤坏死因子α(TNF-α),并比较各炎症因子与患者预后的关系。记录每小时ICP值,以12h为周期,20mm Hg为基线,将该时间段超过20mm Hg的ICP差值累加,得到ICP的时间累积值(PTD-ICP20),将该值分别与该12h周期前(Pre)和后(Post)各炎症因子行直线回归分析。结果血清IL-1β、IL-8及TNF-α均与患者预后显著相关(P<0.05)。本组患者的PTD-ICP20均值为(42.9±60.2)mm Hg/h。Pre-IL-8(r=0.554,P<0.05)、Pre-TNF-α、Post-IL-8及Post-TNF-α均与PTD-ICP20呈正相关(r=0.554、0.597、0.629、0.538,P<0.05)。结论血清IL-8及TNF-α可作为监测脑外伤患者ICP的生物标记物,对指导脑外伤诊治,改善患者预后有重要价值。

Objective This study investigates the relationship of serum inflammatory cytokine levels with intracranial pressure（ICP）in patients with severe traumatic brain injury（TBI）after surgery.Methods A total of 32 cases with severe TBI and placement of ICP monitor were prospectively enrolled.Serum was collected before surgery and every 12 hafter surgery.Cytokines levels of interleukin（IL）-1β,IL-8,and tumor necrosis factor（TNF）-αwere analyzed and compared with outcome of patients.Hourly values of ICP were recorded.The degree of ICP above treatment threshold（20mm Hg）were calculated every 12 has ＂pressure times time dose＂（PTD-ICP20）,which was compared with serum cytokine levels before（Pre）and after（Post）the 12-hour time period using linear regression method.Results Serum IL-1β（P〈0.05）,IL-8（P〈0.01）and TNF-α（P〈0.01）levels elevated dramatically after severe TBI and were significantly associated with outcome of patients.Mean PTD-ICP20was（42.9±60.2）mm Hg/h and was correlated with increased Pre-IL-8（r=0.554,P〈0.001）,Pre-TNF-α（r=0.597,P〈0.001）,Post-IL-8（r=0.629,P〈0.001）and Post-TNF-α（r=0.538,P〈0.001）levels.Conclusion Serum IL-8and TNF-αdemonstrated the most promising candidate biomarkers of impending ICP elevation in this study.These findings indicate a feasible way of monitoring patients with severe TBI.