脑出血术后患者的纤溶系统与免疫炎症反应关系的研究

Study on Correlation between Fibrinolytic System and Immune Inflammatory Response of Postoperative Patients with Cerebral Hemorrhage

目的:探究脑出血术后患者的纤溶系统与免疫炎症反应的关系。方法:将2020年9月—2022年12月宁夏医科大学总医院心脑血管病医院收治的240例脑出血术后患者作为研究对象,根据术后第1天意识障碍程度将其分为神清组、嗜睡组、昏睡组、浅昏迷组、中昏迷组及深昏迷组,各40例。检测及比较六组淋巴细胞免疫指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)及CD19^(+))、纤溶指标[纤维蛋白原(FIB)、纤维蛋白原降解产物(FDP)及D-二聚体(D-D)]、炎症指标(单核细胞、中性粒细胞、淋巴细胞、中性粒细胞/淋巴细胞及血小板/单核细胞),采用Pearson相关性分析纤溶指标与淋巴细胞免疫指标及炎症指标的关系。结果:神清组与嗜睡组淋巴细胞免疫指标及淋巴细胞、血小板/单核细胞比较,差异无统计学意义(P>0.05);六组其他指标比较,差异有统计学意义(P<0.05);深昏迷组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、CD19^(+)及淋巴细胞最低,CD8^(+)、纤溶指标及其他炎症指标最高,其次为中昏迷组、浅昏迷组、昏睡组及嗜睡组。Pearson相关性分析显示,纤溶指标与淋巴细胞、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、CD19^(+)呈负相关(P<0.05),与CD8^(+)、单核细胞、中性粒细胞、中性粒细胞/淋巴细胞、血小板/单核细胞呈正相关(P<0.05)。结论:不同意识障碍程度脑出血术后患者的纤溶系统与免疫炎症反应存在显著差异,且其之间密切相关,在脑出血手术患者中的检测价值较高。

Objective:To investigate the correlation between fibrinolytic system and immune inflammatory response of postoperative patients with cerebral hemorrhage.Method:A total of 240 postoperative patients with cerebral hemorrhage who treated in Cardiovascular and Cerebrovascular Hospital of General Hospital of Ningxia Medical University from September 2020 to December 2022 were selected as the study objects,they were divided into conscious group,sleepiness group,lethargy group,light coma group,medium coma group and deep coma group according to the degree of consciousness impairment at the first day after surgery,with 40 cases in each group.Then the lymphocyte immunity indexes(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)and CD19^(+)),fibrinolytic indexes[fibrinogen(FIB),fibrinogen degradation products(FDP)and D-dimer(D-D)],inflammatory indexes(monocytes,neutrophils,lymphocytes,neutrophil/lymphocyte and platelet/monocyte)of six groups were detected and compared,and pearson correlation analysis was used to analyze the relationship between fibrinolytic indexes and lymphocyte immunity indexes and inflammatory indexes.Result:There were no significant differences in the lymphocyte immunity indexes,lymphocytes and platelet/monocyte between conscious group and sleepiness group(P>0.05);there were significant differences in other indexes among six groups(P<0.05);the CD3^(+),CD4^(+),CD4^(+)/CD8^(+),CD19^(+)and lymphocytes of deep coma group were lowest,and the CD8^(+),fibrinolytic indexes and other inflammatory indexes were highest,the next were medium coma group,light coma group,lethargy group and sleepiness group.Pearson correlation analysis showed the fibrinolytic indexes were negatively correlated with lymphocytes,CD3^(+),CD4^(+),CD4^(+)/CD8^(+),CD19^(+)(P<0.05),and were positively correlated with CD8^(+),monocytes,neutrophils,neutrophil/lymphocyte and platelet/monocyte(P<0.05).Conclusion:The differences of fibrinolytic system and immune inflammatory response of postoperative patients with cerebral hemorrhage of different degree of consciousness impairment are significant,and they have close relationship,so their detection value in the surgical patients with cerebral hemorrhage are higher.