亚低温对重症急性颅脑创伤患者S100-β蛋白、 NSE及认知功能的影响

Effects of sub hypothermia on S100-β protein,NSE and cognitive function in patients with acute severe traumatic brain injury(ASTBI)

目的研究亚低温对重症急性颅脑创伤(ASTBI)患者S100-β蛋白、神经元特异性烯醇化酶(NSE)及认知功能的影响。方法回顾性分析2015年1月-2018年12月成都医学院第一附属医院神经外科治疗ASTBI患者126例,依照随机数字表法分为亚低温组(n=63)与对照组(n=63)。对照组给予对症支持治疗,亚低温组患者给予对症支持治疗+亚低温处理(降温床降温、肌注冬眠合剂)。观察并比较治疗前、治疗7d后两组患者血清白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)等炎性因子水平,S100-β蛋白、NSE等神经损伤因子水平,抗氧化能力(AOA)、谷胱甘肽过氧化物酶(GPx)、丙二醛(MDA)等氧化应激因子水平以及治疗前后蒙特利尔认知评估量表(MoCA)评分。结果治疗7d后,亚低温组IL-6、IL-10、TNF-α、S100-β蛋白、NSE水平均低于对照组(P<0.05)。治疗7d后,亚低温组AOA、GPx水平均高于对照组,MDA水平低于对照组(P<0.05)。治疗后,亚低温组MoCA评分、总有效率均高于对照组(P<0.05)。结论亚低温可保护ASTBI患者脑组织,缓解氧化应激及炎性反应,保护神经元及血脑屏障,避免NSE释放至外周血,抑制生成S100-β蛋白,有助于患者认知功能恢复。

Objective To study the effects of sub hypothermia on S100-βprotein,NSE and Cognitive function in patients with acute severe traumatic brain injury(ASTBI).Methods A total of 126 ASTBI patients admitted in our hospital from Jan.2015 to Dec.2018 were included in this study and divided into sub hypothermia group(n=63)and control group(n=63)according to the therapeutic method.Symptomatic support therapy was performed in control group,and symptomatic support therapy and sub hypothermia treatment(health hotbed cooling,muscle injected hibernation mixture)were performed in sub hypothermia group.The two groups were compared before and 7 d after the treatment in the levels of inflammatory factors such as serum interleukin-6(IL-6)and interleukin-10(IL-10),tumor necrosis factor-α(TNF-α),the levels of nerve damage factors such as serum S100-βprotein and neuron specific enolization(NSE),the levels of oxidative stress factors such as serum antitoxidant activity(AOA),glutathione peroxidase(GPx),malondialdehyde(MDA).Montreal Cognitive Assessment(MoCA)scale was recored and compared before and after treatment.Results After 7 d of treatment,the levels of IL-6,IL-10,TNF-α,S100-βprotein and NSE in sub hypothermia group were lower than those in the control group(P<0.05).After treatment for 7 d,AOA and GPx levels in sub hypothermia group were higher than those in the control group,MDA levels were lower than those in the control group(P<0.05).After treatment,MoCA score and total effective rate in sub hypothermia group were higher than those in the control group(P<0.05).Conclusion Sub hypothermia can protect brain tissue of ASTBI patients,relieve oxidative stress and inflammatory reaction,protect neurons and blood-brain barrier from release of NSE to peripheral blood,inhibit the generation of S100-βprotein,and promote the recovery of cognitive function.