血清粒细胞-巨噬细胞集落刺激因子、肿瘤坏死因子α及C反应蛋白水平与颅脑损伤患者病情严重程度及预后的关系

Relationship Between Serum Levels of GM-CSF,TNF-α,CRP and Disease Severity,Prognosis of Patients With Craniocerebral Trauma

目的探讨血清粒细胞-巨噬细胞集落刺激因子(GM-CSF)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)水平与颅脑损伤患者病情严重程度及预后的关系。方法选取2013年6月—2014年12月广西壮族自治区人民医院外科收治的颅脑损伤患者128例作为颅脑损伤组,同期体检健康者40例作为对照组。根据格拉斯哥昏迷量表(GCS)评分将颅脑损伤患者分为轻度组44例、中度组53例和重度组31例;根据治疗后6个月日常生活能力分级将颅脑损伤患者分为预后良好组104例和预后不良组24例。比较对照组与颅脑损伤组受检者入院24 h血清GM-CSF、TNF-α、CRP水平,不同病情严重程度颅脑损伤患者入院24 h及治疗3、7、14 d后血清GM-CSF、TNF-α、CRP水平,不同预后颅脑损伤患者入院24 h血清GM-CSF、TNF-α、CRP水平。结果颅脑损伤组患者入院24 h血清GM-CSF、TNF-α、CRP水平高于对照组(P<0.05)。时间与病情严重程度在血清GM-CSF、TNF-α、CRP水平上存在交互作用(P<0.05);病情严重程度在血清GM-CSF、TNF-α、CRP水平上主效应显著(P<0.05);时间在血清GM-CSF、TNF-α、CRP水平上主效应显著(P<0.05);中度组和重度组患者入院24 h及治疗3、7、14 d后血清GM-CSF、TNF-α、CRP水平高于轻度组,重度组患者入院24 h及治疗3、7、14 d后血清GM-CSF、TNF-α、CRP水平高于中度组(P<0.05)。预后不良组患者入院24 h血清GM-CSF、TNF-α、CRP水平高于预后良好组(P<0.05)。结论血清GM-CSF、TNF-α、CRP水平可判断颅脑损伤患者病情严重程度,且对患者预后具有一定的预测价值。

Objective To investigate the relationship between serum levels of GM-CSF,TNF-α,CRP and disease severity,prognosis of patients with craniocerebral trauma. Methods From June 2013 to December 2014 in the Department of Surgery,the People’s Hospital of Guangxi Zhuang Autonomous Region,a total of 128 patients with craniocerebral trauma were selected as case group,a total of 40 healthy cases admitted to this hospital for physical examination were selected as control group. Patients of case group were divided into A group( with mild craniocerebral trauma,n = 44),B group( with moderate craniocerebral trauma,n = 53) and C group( with severe craniocerebral trauma, n = 31) according to GCS score, into D group( with good prognosis, n = 104) and E group( with poor prognosis, n = 24) according to ADL classification after 6months of treatment. Serum levels of GM-CSF,TNF-α and CRP after 24 hours of admission were compared between control group and case group,above index were compared among A group,B group and C group after 24 hours of admission,after 3 days,7days and 14 days of treatment,above index after 24 hours of admission were compared between D group and E group. Results Serum levels of GM-CSF,TNF-α and CRP after 24 hours of admission of case group were statistically significantly higher than those of control group( P < 0. 05). There was interaction between time and disease severity for serum levels of GM-CSF,TNF-αand CRP( P < 0. 05); disease severity has significant main effect on serum levels of GM-CSF,TNF-α and CRP( P < 0. 05);time has significant main effect on serum levels of GM-CSF,TNF-α and CRP( P < 0. 05); after 24 hours of admission,after 3 days,7 days and 14 days of treatment,serum levels of GM-CSF,TNF-α and CRP of B group and C group were statistically significantly higher than those of A group,and above index of C group were statistically significantly higher than those of B group( P < 0. 05). Serum levels of GM-CSF,TNF-α and CRP after 24 hours of admission of E group were statistically significantly higher than those of D group( P < 0. 05). Conclusion Serum levels of GM-CSF, TNF-α and CRP can judge the disease severity of patients with craniocerebral trauma,has certain predictive value on the prognosis.