颈总动脉交感神经网剥脱术对混合型脑性瘫痪临床疗效及血清IL-6、IL-10、TNF-α水平的影响

Effect of Common Carotid Artery Sympathectomy on Clinical Efficacy and Serum Levels of IL-6, IL-10 and TNF-α in Patients with Mixed Cerebral Palsy

目的探讨颈总动脉交感神经网剥脱术对混合型脑性瘫痪儿童临床疗效及血清炎性细胞因子的影响。方法对50例混合型脑性瘫痪儿童行颈总动脉交感神经网剥脱术,比较手术前后白细胞介素(interleukin,IL)-6、IL-10、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平及改良Ashworth痉挛评分、教师流涎(teacher drooling scale,TDS)分级和粗大运动功能分类系统(gross motor function classification system,GMFCS)改善情况。结果50例混合型脑性瘫痪儿童术后IL-6、TNF-α水平较术前降低,差异有统计学意义(P<0.05);术后IL-10水平较术前差异无统计学意义(P>0.05)。术后改良Ashworth痉挛评分及TDS分级较术前改善,差异有统计学意义(P<0.05);术后GMFCS程度较术前无改善,差异无统计学意义(P>0.05)。手术前后TNF-α水平与改良Ashworth痉挛评分及TDS分级均呈正相关,手术前后TNF-α水平与GMFCS程度无相关性;手术前后IL-6、IL-10水平与改良Ashworth痉挛评分、TDS分级、GMFCS程度均无相关性。结论IL-6、IL-10、TNF-α参与了混合型脑性瘫痪的发病过程,而颈总动脉外膜交感神经网剥脱术可通过降低IL-6、TNF-α水平达到改善临床症状的效果,值得推广应用。

Objective To investigate the effect of common carotid artery sympathectomy on clinical efficacy and serum inflammatory factors in children with mixed cerebral palsy.Methods Common carotid artery sympathectomy was performed in 50 children with mixed cerebral palsy.The levels of IL-6,IL-10,TNF-α,modified Ashworth spasm score,teacher drooling scale(TDS)grade and gross motor function classification system(GMFCS)were compared before and after operation.Results The levels of IL-6 and TNF-αin 50 children with mixed cerebral palsy after operation were significantly lower than those before operation,and the difference was statistically significant(P<0.05);but there was no significant difference in the level of IL-10 after operation.The modified Ashworth spasm score and TDS grade after operation were significantly better than those before operation,and the differences were statistically significant(P<0.05);but there was no significant difference in GMFCS after operation(P>0.05).The level of TNF-αbefore and after operation was positively correlated with modified Ashworth spasm score and TDS grade,but there was no correlation between TNF-αlevel and GMFCS before and after operation,and there was no correlation between IL-6,IL-10 level and modified Ashworth spasm score,TDS salivation grade and GMFCS before and after operation.Conclusion IL-6,IL-10 and TNF-αare involved in the pathogenesis of mixed cerebral palsy,and common carotid artery adventitia sympathectomy can improve clinical symptoms by reducing the levels of IL-6 and TNF-α,which is worth of popularization and application.