劉永剛 張學勇 姜鳳 姜堯佳 任秀敏
【摘要】 目的:探究炎性因子IL-1β與出血性腦水腫形成的相關(guān)性。方法:選取2017年4月-2018年8月出血性腦水腫形成患者240例。按出血性腦水腫形成患者出血時間分為8、16、24、48、72、
120 h組,各40例,并選取200例同期非出血性腦水腫的腦損傷患者作為對照組。比較各組腦水腫體積、血清IL-1β水平,探討IL-1β與出血性腦水腫形成的相關(guān)性。結(jié)果:各組腦水腫體積、血清IL-1β水平比較,差異均有統(tǒng)計學意義(P<0.05),其中8~72 h組隨著時間的延長,患者腦水腫體積、血清IL-1β水平越高,120 h腦水腫體積、血清IL-1β水平均低于72 h,總體均呈逐漸上升至頂峰后逐漸下降的趨勢;經(jīng)線性回歸分析后發(fā)現(xiàn),IL-1β與出血性腦水腫呈正相關(guān)(r=0.573,P<0.05)。結(jié)論:炎性因子IL-1β與出血性腦水腫形成呈正相關(guān),臨床可通過檢測IL-1β指標來判斷患者腦水腫情況,可為臨床選擇手術(shù)還是保守治療提供輔助判定依據(jù),此方法值得應用與推廣。
【關(guān)鍵詞】 出血性腦水腫; 炎性因子; IL-1β; 相關(guān)性
Correlation Study of Inflammatory Factor IL-1β with Hemorrhagic Brain Edema/LIU Yonggang,ZHANG Xueyong,JIANG Feng,et al.//Medical Innovation of China,2019,16(06):-122
【Abstract】 Objective:To explore the correlation of inflammatory factor IL-1β with hemorrhagic brain edema.Method:A total of 240 hemorrhagic brain edema patients treated in our hospital from April 2017 to August 2018 were selected.According to the time of hemorrhage,they were were divided into 8,16,24,48,72 and 120 h groups,40 cases in each group,and 200 cases of non-hemorrhagic brain edema patients in the same period were selected as control group.The volume of brain edema and the level of serum IL-1β in each group were compared,the correlation between IL-1β and the formation of hemorrhagic brain edema was analyzed.Result:The volume of brain edema and the level of serum IL-1β in each group were compared,the differences were statistically significant(P<0.05),the volume of brain edema and the level of serum IL-1β increased with the prolongation of time in the 8-72 h group,while the volume of brain edema and the level of serum IL-1β at 120 h group were lower than 72 h group,and the overall trend was gradually rising to the peak and then gradually declining.Linear regression analysis showed that IL-1β was positively correlated with hemorrhagic brain edema(r=0.573,P<0.05).Conclusion:Inflammatory factor IL-1β is positively correlated with the formation of hemorrhagic brain edema.Clinical examination of IL-1β can be used to determine the condition of brain edema in patients.It can provide an auxiliary basis for clinical selection of surgery or conservative treatment.This method is worthy of application and promotion.
【Key words】 Hemorrhagic brain edema; Inflammatory factor; IL-1β; Correlation
First-authors address:First Affiliated Hospital of Jiamusi University,Jiamusi 154000,China
doi:10.3969/j.issn.1674-4985.2019.06.032
腦出血是全世界范圍內(nèi)致殘致死率最高的疾病之一,并且近年來其發(fā)病率呈現(xiàn)逐年上升的趨勢,據(jù)不完全統(tǒng)計結(jié)果顯示[1],目前我國腦出血患者發(fā)生率占據(jù)腦卒中患者的33%,盡管部分患者搶救存活,仍然存在不同程度的功能障礙,對其生活質(zhì)量造成嚴重影響。腦出血發(fā)生后,過多的液體積聚在腦組織的細胞外間隙和/或細胞內(nèi),形成腦水腫,如果沒有及時有效地使用藥物等方法予以干預,易發(fā)生腦疝,嚴重時甚至導致患者死亡,對患者生命造成嚴重威脅[2-3]。因此,腦水腫的早期診斷與監(jiān)測顯得尤為重要。動物實驗顯示,IL-1β參與了腦損害的發(fā)生[4],腦出血后的炎癥反應是出血后神經(jīng)元繼發(fā)性損害及神經(jīng)功能障礙加重的重要因素,本研究通過對不同時間段的出血性腦水腫患者進行IL-1β表達檢測,探究炎性因子IL-1β與出血性腦水腫形成的相關(guān)性,現(xiàn)報道如下。
參考文獻
[1]張潔,李劍,邢巖,等.TNF-α作用于小鼠腦血管內(nèi)皮細胞產(chǎn)生IL-1、ET受體機制[J].腦與神經(jīng)疾病雜志,2016,24(4):224-226.
[2]張俊峰.顱腦外傷患者腦血液中IL-6、BNP、CRP表達臨床分析[J].海南醫(yī)學院學報,2015,21(9):1219-1221.
[3]是文輝,許永華,宋來陽,等.急性低氧暴露下大鼠腦組織的病理學改變及腦IL-6、TNF-α的表達變化[J].實驗動物科學,2016,33(4):58-62.
[4]矯淑芹.化膿性腦膜炎、病毒性腦炎血清及腦脊液中IL-1β和MMP-9水平的差異及其臨床意義[J].海南醫(yī)學院學報,2016,22(2):178-181.
[5]李敬.腦出血患者腦脊液IL-1β TNF-α和CRP含量的變化及臨床意義[J].中國實用神經(jīng)疾病雜志,2018,21(4):417-419.
[6]王凌嘯,鄭錫銘.缺血缺氧性腦病新生兒血清IL-1β、IL-6和TNF-α水平變化及其臨床意義[J].中國實用醫(yī)刊,2017,44(2):72-74.
[7]Ciccia F,Guggino G,Rizzo A,et al.Interleukin(IL)-22 receptor 1 is over-expressed in primary Sjogrens syndrome and Sjogren-associated non-Hodgkin lymphomas and is regulated by IL-18[J].Clin Exp Immunol,2015,181(2):219-229.
[8]鐘寶,萬野,鄒敏,等.顱腦損傷后血清IL-1βIL6的變化及臨床意義[J].中國實用神經(jīng)疾病雜志,2018,21(2):184-187.
[9]蘇航,康小剛.慢性腦缺血性認知功能障礙患者血清中白細胞介素-1β和腫瘤壞死因子-α的臨床診斷意義[J].中國慢性病預防與控制,2015,23(9):698-699.
[10]王健,孫月明,秦麗娟.白介素-1β增加血腦腫瘤屏障通透性的作用機制[J].中國藥理學通報,2016,32(1):94-97.
[11]張江,常莉莎,王大力,等.遠程缺血后適應中大鼠海馬CA1區(qū)TLR4和IL-6的表達變化及其意義[J].中國免疫學雜志,2015,31(8):1045-1048.
[12]盧俏麗,李晨,宋迎,等.腦微出血發(fā)生的危險因素及與炎癥介質(zhì)關(guān)系的分析[J].中華老年心腦血管病雜志,2016,18(10):1066-1069.
[13]Murtha L A,McLeod D D,Pepperall D,et al.Intracranial pressure elevation after ischemic stroke in rats:cerebral edema is not the only cause,and short-duration mild hypothermia is a highly effective preventive therapy[J].J Cereb Blood Flow Metab,2015,35(4):592-600.
[14]鄭鵬斌,萬晨光,馮學泉,等.豬腦死亡對血清ET-1及TNF-α、IL-1β、IL-6表達影響的初步研究[J].中國醫(yī)學創(chuàng)新,2016,13(35):6-10.
[15]De Guio F,Mangin J F,Duering M,et al.White Matter Edema at the Early Stage of Cerebral Autosomal-Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy[J].Stroke,2015,46(1):258-261.
[16]鄭云鋒,李霞,賈云峰,等.模型大鼠在電磁脈沖作用下大腦額葉皮層TNF-α、IL-1β、IL-6和NFκB p65表達的變化[J].神經(jīng)解剖學雜志,2018,34(1):102-106.
[17]蔣令修,粱宇,陳文武,等.急性基底節(jié)腦出血IL-4、IL-6、IL-8及IL-10與周圍腦組織水腫的相關(guān)性分析[J].中國現(xiàn)代醫(yī)生,2015,53(34):25-27.
[18]Hadanny A,Golan H,F(xiàn)ishlev G,et al.Hyperbaric oxygen can induce neuroplasticity and improve cognitive functions of patients suffering from anoxic brain damage[J].Restor Neurol Neurosci,2015,33(4):471-486.
[19]王佳,張紅玉.不同程度顱腦損傷后炎癥因子的表達及其臨床意義[J].中國現(xiàn)代醫(yī)學雜志,2016,26(3):72-75.
[20] Tan L A,Lopes D K.Surgical management of malignant cerebral edema secondary to immune reconstitution inflammatory syndrome from natalizumab-associated progressive multifocal encephalopathy[J].J Clin Neurosci,2015,22(10):1669-1671.