血钙变化通过内质网应激途径加重颅脑外伤患者神经损伤的临床研究

Clinical study on the changes of serum calcium aggravate nerve injury in patients with traumatic brain injury through endoplasmic reticulum stress

目的探讨颅脑外伤患者血钙变化是否通过内质网应激途径加重脑损伤。方法选取2017年9月—2019年10月新疆医科大学第一附属医院急救创伤中心创伤重症医学科及神经外科收治颅脑外伤患者138例,根据病情分为轻度组56例、中度组49例、重度组33例。比较3组患者血钙水平、神经损伤标志物、单胺类神经递质、坏死脑组织中内质网应激途径相关蛋白水平的差异,并采用Pearson检验分析颅脑外伤患者血钙水平与上述3类指标的相关性。结果随颅脑外伤程度加重,血钙水平下降(F/P=73.984/0.000),血清MBP、NSE、S100B水平增加(F/P=146.139/0.000、127.464/0.000、91.497/0.000);血清Glu、Asp水平增加,Gly、GABA水平降低(F/P=103.137/0.000、108.540/0.000、110.022/0.000、110.287/0.000);坏死脑组织中P-eIF2α阳性表达率增加,GADD34阳性表达率下降(F/P=363.203/0.000、127.693/0.000)。颅脑外伤患者血钙水平与神经损伤标志物MBP、NSE、S100B水平呈负相关(r=-0.498、-0.672、-0.574,P均<0.05);与单胺类神经递质GLU、Asp水平呈负相关,与Gly、GABA水平呈正相关(r=-0.661、-0.548、0.499、0.621,P均<0.05);与脑组织中内质网应激途经相关蛋白P-eIF2α的阳性表达率呈负相关,与GADD34的阳性表达率呈正相关(r=-0.712、0.657,P均<0.05)。结论颅脑外伤患者血钙水平较低,可能是导致患者脑损伤加重的原因,内质网应激途径是其发挥作用的机制之一。

Objective To investigate whether the changes of serum calcium in patients with traumatic brain injury aggravate brain injury through endoplasmic reticulum stress.Methods From September 2017 to October 2019,138 patients with craniocerebral trauma were selected from the Department of Trauma Critical Medicine and Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University.The patients were divided into mild group(56 cases),moderate group(49 cases)and severe group(33 cases).The levels of serum calcium,nerve injury markers,monoamine neurotransmitters and endoplasmic reticulum stress pathway related proteins in necrotic brain tissue were compared among the three groups,and the correlation between serum calcium level and the above three indexes was analyzed by Pearson test.Result:As the degree of craniocerebral trauma worsened,blood calcium levels decreased(F/P=73.984/0.000),and serum MBP,NSE,and S100B levels increased(F/P=146.139/0.000,127.464/0.000,91.497/0.000).Serum Glu and Asp levels increased,and Gly and GABA levels decreased(F/P=103.137/0.000,108.540/0.000,110.022/0.000,110.287/0.000).The positive expression rate of P-eIF2αin necrotic brain tissue increased,and the positive expression rate of GADD34 decreased(F/P=363.203/0.000,127.693/0.000).Serum calcium levels in patients with craniocerebral trauma are negatively correlated with neural damage markers(MBP,NSE,and S100B)levels(r=-0.498,-0.672,-0.574,all P<0.05);it is negatively correlated with monoamine neurotransmitter(GLU and Asp)levels,and positively with Gly and GABA levels Correlation(r=-0.661,-0.548,0.499,0.621,all P<0.05).There was a negative correlation with the positive expression rate of brain tissue endoplasmic reticulum stress pathway protein P-eIF2α,and a positive correlation with the positive expression rate of GADD34(r=-0.712,0.657,both P<0.05).Conclusion The low level of serum calcium in patients with traumatic brain injury may be the reason for the aggravation of brain injury.Endoplasmic reticulum stress pathway is one of its mechanisms.