急性颅脑损伤外周血C反应蛋白和白细胞计数的临床研究

Clinical research of peripheral blood C-reactive protein and white blood cell count in acute craniocerebral injury

目的探讨急性颅脑损伤患者外周血中C反应蛋白(CRP)和白细胞(WBC)计数动态变化与颅脑损伤程度及预后的关系。方法测定206例急性颅脑损伤患者在3 h、24 h、2~30 d(或出院时)外周血中CRP和WBC计数,根据格拉斯哥昏迷评分法(GCS)分型和格拉斯哥预后评分法(GOS)分级,分析CRP、WBC计数与不同类型颅脑损伤患者病情演变及预后的关系。结果 CRP水平与GCS评分呈负相关(r=-0.582,P<0.05),轻、中、重型颅脑损伤组患者外周血中CRP在伤后3 h均开始升高,第4天达高峰,轻型颅脑损伤组在第5天开始回落,第7天恢复正常,中型颅脑损伤组在第14天基本恢复正常,重型颅脑损伤组第30天仍然高于正常。WBC计数与GCS评分呈负相关(r=-0.267,P<0.05),轻、中、重型颅脑损伤组患者伤后3 h外周血中WBC计数均开始升高,24 h达到高峰,随后渐回落,第7天及出院时恢复正常。CRP水平与GOS评分呈负相关(r=-0.267,P<0.05),WBC计数与GOS评分呈负相关(r=-0.392,P<0.05)。结论外周血CRP和WBC计数可作为判断急性颅脑损伤程度及预后的重要监测指标。

Objective To investigate dynamic changes of peripheral blood C-reactive protein（CRP） and white blood cell（WBC） count in acute craniocerebral injury and their relationship with craniocerebral injury degree and prognosis. Methods Detection was made on CRP and WBC count in 206 acute craniocerebral injury patients at 3 h, 24 h, 2-30 d（at discharge）. On the base of Glasgow coma scale（GCS） classification and Glasgow outcome score（GOS） grade, analysis was made on relationship between CRP, WBC count and disease evolution, prognosis in different types of acute craniocerebral injury patients. Results CRP level was negatively correlated with GCS score（r=-0.582, P〈0.05）. All patients with mild, moderate and severe craniocerebral injury had increased peripheral blood CRP in 3 h after injury, and reached peak value in 4 d. Mild craniocerebral injury group had reduced CRP from 5 d, and recovered standard level at 7 d. Moderate craniocerebral injury group had recovered standard level at 14 d, while severe craniocerebral injury group still had higher CRP level than standard at 30 d. WBC count was negatively correlated with GCS score（r=-0.267, P〈0.05）. All patients with mild, moderate and severe craniocerebral injury had increased peripheral blood WBC count in 3 h after injury, and reached peak value in 24 h and gradually reduced afterwards. They all had recovered standard level at discharge in 7 d. CRP level was negatively correlated with GOS score（r=-0.267, P〈0.05）, and WBC count was negatively correlated with GOS score（r=-0.392, P〈0.05）. Conclusion Peripheral blood CRP and WBC count can be taken as important monitoring indexes in judgment of acute craniocerebral injury degree and prognosis.