颅脑伤合并吸入性肺损伤患者肺组织细胞凋亡的研究

Study on apoptosis of lung tissue cells in patients with severe brain injury com plicated with aspiration-induced lung injury

目的 探讨肺组织细胞凋亡在颅脑伤合并吸入性肺损伤患者病理过程中的作用。方法 重型闭合性颅脑外伤死亡患者 11例 ,格拉斯哥昏迷评分 (GCS)为 3～ 8分。明确诊断后归入并发吸入性肺损伤组(AIL I组 ,5例 )和无吸入性肺损伤组 (NAIL I组 ,6例 ) ,采用放射免疫方法检测患者血浆肿瘤坏死因子 α(TNFα)及白细胞介素 8(IL 8)水平 ,并对其尸体肺组织进行病理观察及细胞凋亡原位检测。结果 NAIL I组及 AIL I组血浆 TNFα水平分别为 (2 .17± 0 .4 1) μg/L 与 (3.14± 0 .2 8) μg/L;血浆 IL 8水平分别为 (0 .4 2± 0 .0 5 ) μg/L 与 (0 .91± 0 .0 8) μg/L(P均 <0 .0 5 ) ;与 NAIL I组相比 ,AIL I组肺组织细胞凋亡率明显增高 (P<0 .0 1)。结论 肺组织细胞凋亡在颅脑伤合并吸入性肺损伤患者病理过程中可能具有重要作用。

Objective To investigate the rol e of apoptosis of pulmonary cells in aspiration induced lung injury in patients wi th severe brain injury with or without aspiration-induced lung injury . Methods The Glasgow scale(GCS) of 11 dead patients with severe closed brain injury w as 3-8. There 11 cases were divided into aspiration-induce d lung injury (AILI) and non-aspiration-induced lung injur y (NAILI)groups. The plasma levels of tumor necrosis factor-α(TNF -α) and interleukin-8(IL-8) were measured, and t he ratio of apoptosis in lung tissue cells was also determined. Results The plasma levels of TNF-α and IL-8 in NAILI and AILI gro ups were (2.17±0.41)μg/L vs. (3.14±0.28)μg/L and (0.42±0.05)μg/L vs. (0.91±0.08) μg/L(P<0.05) respectively. Lung tissue cell apoptosis r atio was significantly higher in AILI group than NAILI group(P<0.01). Conclusion TNF-α and IL-8 may induce apoptosis in lung tissues t hrough different signaling pathway. During the early phase of aspiration-induced lung injury complicating severe closed brain injury, apoptosis in cells of lung tissue may play a role in the pathogenesis.