急性颅脑损伤患者血清铜、铁、锰的动态变化及其意义

Changes and Significance of Serum Trace Elements (Copper, Iron, and Manganese) after Acute Head Trauma

本组测定29例病人伤后48h内及1周时的血清铜、铁值,13例病人伤后48h内的血清锰值。结果表明,伤后48h内,血清铜升高显著(P<0.01),铁下降明显(P<0.01),锰变化不大(P>0.05)。在排除了手术因素后,结果仍与上述结果基本相同。伤后1周,血清铜仍保持高水平(P<0.01),血清铁恢复正常。作者认为,颅脑损伤急性期,血清铜的升高和血清铁的降低符合"白细胞内源递质"学说;同时,脑组织及含铜酶的破坏,使铜释放入血,也可能是血清铜上升的另一个重要因素,尤其是在伤后48h内。血清铜的升高可能在增强机体防御、阻止脑水肿恶化和组织修复方面起重要的作用。血清铁的下降究竟对机体有利或是有害尚不清楚。

Serum copper and iron were measured in 29 patients within 48 hours, a week after head trauma by flame atomic absorp- tion spectrophotometry, and serum manganese in 13 patients at 48 hours of injury by flameless atomic absorption spectrophotometry. The results presented that serum copper increased greatly (p<0.01), iron lowered very much(p<0.01) and manganese changed somewhat but no significance (p>0.05), within 48 hours of injury, when the factor of operation was excluded. the results were still similar to that described as above. A week after head trauma, serum copper still kept the high level. however, iron got back to a normal level. The authors consider that the mechanism of the changes of serum copper and iron at acute head trauma corresponds with the theory of "Leukocytic Endogenous Mediator", and both the damage to brain tissue and enzymes which contain much copper make copper enter blood flow. might be an important reason for high serum copper level especially within 48 hours of injury. Authors emphasize that the rise of serum copper can play an important role in strenthing the defensive ability and preventing deterioration of brain edema, and can function importantly in tissue repair. It is not clear whether the drop of serum iron is benifit to injuried brain tissue.