急性脑血管病肿瘤坏死因子-α的临床研究

Clinical investigation of tumor necrosis factor-alpha in acute cerebrovascular diseases

目的 探讨肿瘤坏死因子 α(TNF -α)在急性脑血管病 (ACVD)中的作用及其变化的临床意义。方法 选取 95例ACVD患者 ,并设性别及年龄相匹配的血清对照组 (2 0例 )及脑脊液对照组 (10例 )。应用酶联免疫吸附法 (ELISA)于发病后第 1、3、7、14d测定血清和脑脊液中TNF -α。结果 ①三种脑血管病患者血清TNF -α动态变化存在差异 ,脑出血和脑梗死组的峰值时间为发病后第 3d ,而蛛网膜下腔出血 (SAH)组为第 1d。②脑梗死患者血清TNF -α水平与梗死面积、神经功能缺损程度及病情恶化与否相关。③SAH组于发病后第 1d、3d、7d脑脊液TNF α值高于血清 ,14d时降至对照组水平并与血清值无差异。结论 ①脑梗死患者血清TNF -α的动态观察 ,可为临床预测梗死灶大小、神经功能缺损程度及病情恶化与否提供依据。②发病早期的脑梗死患者若CT未能显示病灶时 ,血清TNF -α的明显升高有助于临床诊断和治疗。③SAH患者脑脊液中TNF -α水平明显高于血清 ,进一步提示脑内神经组织可产生TNF -α。脑脊液中TNF -α的持续明显升高可能与SAH后脑血管痉挛有关。④TNF -α参与了ACVD的炎性反应过程 。

Objective To investigate the role of TNF-α in acute cerebrovascular diseases (ACVD) and the clinical significance of tumor necrosis factor changes. Methods Ninty-five patients were chosen.Healthy people matched with age and sex were selected as the serum control(20 subjects)and cerebrospinal fluid(CSF) control(10 subjects). On the days 1,3,7 and 14 after episode respectively,TNF-α in serum and CSF were measured by using enzyme-linked immuno-sorbent assay (ELISA). Results ①The serum dynamic changes of TNF-α were significantly different among three diseases. The serum TNF-α got to peak on the third day for the groups of cerebral infarction and cerebral hemorrhage. While the peak time of TNF-α was on the first day for the group of SAH.②The serum TNF-α level of patients with cerebral infarction correlated with the infarctional area, degree of neurologic impairment and deterioration of the patients.③For SAH patients, the TNF-α of CSF was higher than that of serum on days 1,3 and 7, and dropped to the control level and had no differences with that of serum on day 14. Conclusion ①For patients with cerebral infarction, the dynamic observation of serum TNF-α might clinically provide some bases for predicting the infarction area, neurologic impairment and deterioration.②For early cerebral infarction patients, if brain CT can not find any significant lesion, the obvious improvement of serum TNF-α is helpful for clinical diagnosis and treatment.③The CSF TNF-α of SAH is higher compared with the serum, showing that neurological tissue in brain can produce TNF-α. Continuously rising TNF-α in CSF may be correlated with cerebrovascular spasm after SAH.④TNF-α involves in the inflammatory progress of ACVD. Early inhibiting its production and anti-inflammatory strategy may have potential clinical value.