地塞米松对脑挫裂伤病人自身免疫反应的影响

The effect of dexamethasone on the autoimmunity in patients with cerebral contusion

目的 研究地塞米松对脑挫裂伤病人自身免疫反应的影响。方法 将同 1d收住院的性别、年龄、病情相似的两个单纯脑挫裂伤病人进行配对 ,其中一个病人入院后即给予地塞米松 (每日 2 0mg以上 ) ,另一个不给予地塞米松及其它任何免疫抑制剂 ,但其它治疗相同。如果配对的两个病人伤后4～ 6d均需要手术治疗 ,这对病人即进入试验。于术中切取脑挫裂伤组织 ,用免疫组化法观测脑组织中淋巴细胞和单核细胞数量。比较配对病人脑组织中免疫细胞数量 ,采用质反应开放型单向配对序贯试验判定地塞米松对脑挫裂伤后自身免疫反应的抑制作用。结果 给予地塞米松的病人脑挫裂伤组织中淋巴细胞和单核细胞计数均少于不使用地塞米松的病人。当试验进行到第 7对病人时 ,试验线触及序贯试验图上边界线。结论 地塞米松能够明显减少免疫细胞在脑组织中浸润、有效抑制脑挫裂伤后自身免疫反应。

Objective To study the effect of dexamethasone on the autoimmunity in patients with cerebral contusion.Methods The patients with cerebral contusion admitted on the same day who were similar in sex,age and GCS were selected as a pair.One patient in a pair was administered dexamethasone while the other one was not.But there was no difference in other treatment between the two patients.Contused brain tissue biopsies were respectively obtained from the patients of a pair undergoing surgery for intracerebral delayed hematoma or edema 4 to 6 days after trauma,and lymphocytes and monocytes were quantified by immunohistochemistry.Sequential trial was used to analyze the results.Results The density of lymphocytes and monocytes was lower in patients receiving dexamethasone than that in patients not receiving dexamethasone.When the result of the 7th pair of the patients was marked on the sequential graph ,the trial line touched its upper border line.Conclusion Dexamethasone can significantly reduce the density of lymphocytes and monocytes in contused brain tissue and effectively attenuate the autoimmunity resulting from cerebral contusion.