糖皮质激素对重度颅脑损伤患者血浆TNF-α、IL-1β水平的影响

目的 研究糖皮质激素对颅脑损伤患者血浆肿瘤坏死因子α（TNF-α）、白细胞介素-1β（IL-1β）水平的影响。方法 随机将重度颅脑损伤患者分为激素治疗组（20例）与非激素治疗对照组（22例），激素组给予地塞米松10mg／d，共7d。正常组选择健康体检者15例。采用ELSIA法检测两组患者伤后第1、2、7、14天血浆中TNF一仪、IL-1β含量。结果 在颅脑损伤第1、2天激素组血浆TNF-α、IL-1β水平明显高于正常组（P（0．01），在第7、14天明显低于非激素组（P（0．01），但与正常组无明显差异（P〉0．05）。非激素组血浆TNF-α、IL-1β水平在各时间点均明显高于正常组（P〈0．01）。结论 糖皮质激素对降低颅脑损伤患者血浆TNF-α、IL-1β水平具有明显的延迟性，使损伤早期因TNF-α、IL-1β显著升高引起的有害作用未能消除，至恢复期又使TNF-α、IL-1β明显降低，其神经保护作用不能发挥。

Effect of Glucocorticosteroid on Plasma Levels of TNF-α and IL-1β in Patients with Severe Traumstic Brain Injury

Objective To investigate the effect of glucocorticosteroid on plasma level of TNF-α and IL-1β in the patients with severe traumatic brain injury （TBI）. Methods Forty-two patient with severe TBI were randomly divided into gncocorticosteriod treatment group （20 case） and control group （22 case）. Each patient in the treatment group were given 10 mg dexamethasone every day for 7 days. The patients in the control group were given the same treatment as ones in all the treatment group except for dexamethasone. TNF-α and IL-1β in the plasma were detected by ELISA 1, 2, 7 and 14 days after the TBI in all the patients and 15 healthy people. Results The plasma levels of TNF-α and IL-1βin the control group 1, 2,7 and 14 days after TBI were significantly higher than those in the normal group （P〈0.01）. The plasma levels of TNF-α and IL-1β in the treatment group 1 and 2 days after TBI were significantly higher than that in the normal group （P〈0.01）. The plasma level of TNF-α and IL-1β7 and 14 days after TBI in the treatment group were significantly lower than those in the control group （P〈0.01） and insignificantly higher than those in the normal group （P〉0.05）. Conclusions Glucocorticosteroid is of obviously tardy effect on decreasing plasma levels of TNF-α and IL-1β in patients with TBI, and it can not eliminate detrimental effect originated by TNF-α and IL-1β in earlier period of TBI. Furthermore the low plasma levels of TNF-α and IL-1β caused by glucocorticosteroid did not exert neuroprotective effect during convalescent period. Maybe the effect of glucocorticosteroid on TNF-α and IL-1β is one of disadvantage factors in the patient with TBI.