急性颅脑损伤后胰岛素抵抗、血清IL-6的相关性研究

目的探讨不同程度、不同时间段急性颅脑损伤患者血糖、胰岛素水平关系及血清白细胞介素-6(IL-6)的含量变化及临床意义。方法 106例急性颅脑损伤患者按入院时GCS评分分为轻度、中度和重度3组,分别于伤后1、2、3、4、5d测定空腹血糖、血清胰岛素值并计算胰岛素抵抗指数(HOMA-IR),分析急性颅脑损伤程度与HOMA-IR之间关系;采用酶联免疫吸附(ELISA)法测定血清IL-6含量,根据IL-6的动态变化,分析急性颅脑损伤程度与血清IL-6含量之间关系。结果不同程度的急性颅脑损伤患者血糖、胰岛素水平及HOMA-IR比较差异有统计学意义(P<0.05),血糖、血清胰岛素和HOMA-IR越高,急性颅脑损伤的程度越重,同时血清IL-6含量在伤后高于对照组(P<0.05),而在重型颅脑损伤中增高较轻型和中型颅脑损伤更为明显(P<0.05)。结论空腹血糖值、HOMA-IR及血清IL-6含量与急性颅脑损伤程度存在相关性,可作为评估急性颅脑损伤严重程度及预后的一个客观指标。

Effects of mild hypothermia on patients with lower intracranial pressure following severe brain injury

Objective: To study the effects of mild hypothermia therapy on severe brain-injured patients whose intracranial pressure (ICP) could be maintained below 25 mm Hg.Methods: Forty severe brain-injured patients with ICP below 25 mm Hg were divided randomly into one treatment group (n=20, mild hypothermia therapy) and one control group (n=20, normothermia therapy) to observe the changes of the concentration of excitatory amino acids (glutamate and glycine) and cytokines (interleukin-1β and interleukin-6). Results: There were no significant differences in the daily changes of the concentration of excitatory amino acid and cytokines between two groups. The outcome of two groups had no significant differences. Conclusions: Mild hypothermia has no additional beneficial effects on severe brain-injured patients compared with normothermia therapy if ICP can be maintained below 25 mm Hg by using conventional therapy.