中脑周围非动脉瘤性蛛网膜下腔出血患者的TNF-α变化及临床意义

Changes and significance of TNF-α in patients with perimesencephalic nonaneurysmal subarachnoid hemorrhage

目的检测肿瘤坏死因子α(TNF-α)在中脑周围非动脉瘤性蛛网膜下腔出血(PNSH)患者血清中的浓度,探讨其变化的临床意义。方法选取我院2013年1月至2016年11月收治的PNSH患者和动脉瘤性蛛网膜下腔出血(ASAH)患者各40例作为PNSH组和ASSH组,另选取本院同期健康体检者40例作为对照组。所有患者于第1天、第5天、第7天、第14天抽取血液样本,采用ELISA法测定血清中TNF-α的浓度。结果与对照组比较,PNSH组和ASAH组患者血清TNF-α水平明显上升,第5天达到高峰[(20.57±3.80)pg/m L、(26.15±4.60)pg/m L vs(10.13±2.50)pg/m L],随后开始下降,持续到第7天仍有较高表达[(16.34±3.3)pg/m L、(20.30±2.10)pg/m L vs(10.62±2.17)pg/m L],差异均有统计学意义(P<0.05)。ASAH组TNF-α浓度在相同的时间点明显高于PNSH组,差异有统计学意义(P<0.05)。PNSH组和ASAH组患者的脑血管痉挛(CVS)的程度越重,TNF-α的表达水平越高。PNSH组的CVS发生率为52.5%,明显低于ASAH组的72.5%,差异有统计学意义(P<0.05)。结论 TNF-α可作为鉴别ASAH与PNSH的一个参考指标。

Objective To detect the serum concentration of tumor necrosis factor-α（TNF-α） in patients with perimesencephalic nonaneurysmal subarachnoid hemorrhage（PNSH）, and to explore the clinical significance of changes in TNF-α levels. Methods From Jan. 2013 to Nov. 2016 in our hospital, 40 patients of PNSH（PNSH group） and40 patients of aneurysmal subarachoid hemorrhage（ASAH group） were collected, and 40 healthy persons were selected as control group. Blood samples were collected on the 1stday, the 5thday, the 7thday, the 14 thday, and the concentration of TTNF-α in serum was determined by ELISA. Results Compared with the control group, the levels of serum TNF-α in PNSH group and ASAH group first increased significantly and reached the peak on the 5thday, which were（20.57±3.80） pg/m L in PNSH group,（26.15±4.60） pg/m L in ASAH group versus（10.13±2.50） pg/m L in control group, and then decreased gradually and still kept in a high level on the 7thday, which were（16.34±3.3） pg/m L in PNSH group,（20.30 ±2.10） pg/m L in ASAH group versus（10.62 ±2.17） pg/m L in control group. The differences were all statistically significant（P〈0.05）. At the same time point, the concentration of TNF-α in PNSH group was significantly lower than that of ASAH group（P〈0.05）. In PNSH group and ASAH group, the more serious the cerebral vasospasm（CVS） was, the higher the expression level of TNF-α. The incidence of CVS in PNSH group was significantly lower than that in ASAH group（52.5%vs 72.5%, P〈0.05）. Conclusion TNF-α can be used as a reference index for differential diagnosis of ASAH and PNSH.