急性期脑出血患者血清炎症因子、超敏C反应蛋白水平的变化及临床意义

Changes of serum inflammatory factors and high-sensitivity C-reactive protein levels in patients with acute intracerebral hemorrhage and their clinical significance

目的探讨急性期脑出血患者血清炎症因子、超敏C反应蛋白(hs-CRP)水平与脑组织水肿相关性。方法选取2016年1月-2017年12月乌鲁木齐市解放军第474医院神经外科收治的脑出血患者78例(脑出血组),均为首次出血,均无死亡病例。病程均在24h之内,选取同期在我院体检中心进行体检者为对照组(60例),2组性别、年龄等基线资料经统计学处理差异无统计学意义(P<0.05),具有可比性。所有患者于入院后第1、3、7天及对照组体检当日抽取清晨空腹静脉血,采用酶联免疫吸附试验(ELISA)检测血清血清白细胞介素1β(IL-1β)、肿瘤坏死因子α(TNF-α),采用免疫比浊法检测超敏C反应蛋白(hs-CRP)水平。结果在脑出血1~3d,脑出血组患者血清中IL-1β、hs-CRP的水平逐渐升高,在第3天2者含量均达到最高值,然后至第7天降至最低,差异有统计学意义(P<0.05)。1~7d血清IL-1β、hs-CRP值明显高于对照组,差异有统计学意义(P<0.05)。脑出血组TNF-α水平在1d时最高,3~7d时水平逐渐降低,7d时,TNF-α水平降至最低,但第7d与第3d时间点时IL-1β比较差异无统计学意义(P<0.05)。在各观察时间点,脑出血组IL-1β水平均高于对照组,差异有统计学意义(P<0.05)。脑出血组不同出血量患者IL-1β水平在不同时间点经比较差异无统计学意义(P>0.05)。大量出血组在不同时间点(1、3、7d)血清TNF-α、hs-CRP水平高于小量出血组和中量出血组,中量出血组血清TNF-α、hs-CRP水平高于小量出血组,经比较差异有统计学意义(P<0.05)。结论脑出血后血清TNF-α、IL-1β、hs-CRP水平均明显升高,并随时间呈动态变化的趋势。其中TNF-α、hs-CRP与病灶出血程度和病情有关,提示以上3种指标在脑出血后灶周水肿的形成过程中起重要作用。

Objective To investigate the correlation between serum inflammatory factors,hs-CRP and brain edema in patients with acute intracerebral hemorrhage.Methods From January 2016 to December 2017,78 patients with intracerebral hemorrhage（ICH group） were admitted to the Department of Neurosurgery,No.474 People′s Liberation Army Hospital in Urumqi.The course of disease was within 24 hours,60 cases were from the Physical examination center for the control group,and gender,age,baseline data of the two groups was comparable（P〈0.05）.Fasting venous blood samples were collected on the 1 st,3 rd,7 th day after admission and on the day of physical examination in the control group.The levels of serum interleukin 1β（IL-1β）and tumor necrosis factorα（TNF-α）were detected by enzyme linked immunosorbent assay.The level of hs-CRP was detected by immunoturbidimetry.Results Serum levels of IL-1βand hs-CRP in patients with intracerebral hemorrhage tended to increase gradually from 1 to 3 days,peaked on the third day and then dropped to the lowest on the 7 th day（P〈0.05）.The levels of serum IL-1βand hs-CRP in the first 7 days were significantly higher than those in the control group（P〈0.05）.The level of TNF-αin the ICH group was the highest at 3 days,decreased gradually at 3-7 days,TNF-αlevel was the lowest at 7 days,but there was no statistical difference at 7 th day and 3 rd day（P〈0.05）.At every observation time spot,the levels of IL-1βin the ICH group were significantly higher than those in the control group（P〈0.05）.But the differences of the levels of IL-1βin the ICH at the observation time spot were no statistical significance（P〈0.05）.The levels of TNF-αand hs-CRP in the massive bleeding group at different time points（1,3,7 d）were higher than those in the small bleeding group and moderate bleeding group.The levels of serum TNF-αand hs-CRP in the moderate bleeding group were higher than those in the small bleeding group,and the difference was statistically significant（P〈0.05）.Conclusion The levels of serum TNF-α,IL-1βand hs-CRP in patients with intracerebral hemorrhage were significantly increased and showed a tendency of dynamic change over the time.Among them,the levels of TNF-α,hsCRP and focal hemorrhage were correlated with the severity of the disease,suggesting that the above three indexes play an important role in the formation of focal edema after intracerebral hemorrhage.