创伤性脑损伤UCH-L1水平与损伤程度、病情变化及预后的相关性分析

目的 探讨创伤性脑损伤后血清泛素羧基末端水解酶(UCH-L1)与脑损伤程度、病情变化及预后的关系. 方法 选择徐州医学院附属淮安医院神经外科自2012年3月至2013年6月收治的创伤性脑损伤患者60例,按格拉斯哥昏迷评分(GCS)分为中度脑损伤组(30例)和重度脑损伤组(30例),另择同期健康体检者30例作为对照.于伤后12h、24 h、2d、3d、5d应用ELISA法检测3组受试者外周静脉血中UCH-L1含量,分析UCH-L1含量与创伤性脑损伤患者影像学表现及预后的关系. 结果 中、重度脑损伤组患者伤后12h、24 h、2d、3d血清UCH-L1浓度高于对照组,重度颅脑损伤组患者伤后12h、24 h、2d、3d时血清UCH-L1浓度高于中度脑损伤组,差异均有统计学意义(P＜0.05);中度脑损伤组患者血清UCH-L1水平于伤后12h达高峰,之后逐渐下降,于伤后5d降至对照组水平;而重度脑损伤组患者血清UCH-L1水平于伤后12h达第1次高峰,此后降低,并于伤后3d再次升高至第2次高峰后下降,5d时降至对照组水平.脑损伤患者UCH-L1水平的变化与影像学表现密切相关,并与预后呈负相关关系(r=-0.412,P=0.030). 结论 创伤性脑损伤血清UCH-L1水平与损伤程度密切相关,对判断病情及预后有重要意义.     

颅脑外伤后血清、脑脊液髓鞘碱性蛋白的变化及其临床意义

目的①探讨颅脑外伤后血清、脑脊液髓鞘碱性蛋白（MBP）的变化及其意义；②探讨血清、脑脊液MBP水平与伤情、CT、颅内压（ICP）、脑灌注压（CCP）的关系。方法采用免疫组化法测定90例颅脑损伤病人伤后24h内、3d、7d时的血清、脑脊液MBP水平，并结合颅脑损伤程度、CT、ICP、CPP进行分析。结果①颅脑损伤病人血清、脑脊液MBP浓度升高的程度与脑损伤程度密切相关；②血浆、脑脊液MBP水平随ICP增加而升高，随CPP增高而降低；③血清、脑脊液MBP水平随CT图像改变而变化。结论监测血清、脑脊液MBP浓度，联合CT、ICP、CPP等指标，可更准确地判断病情。     

新生儿缺氧缺血性脑病临床、CT与烯醇酶、髓鞘碱性蛋白的关系

目的 :探讨NSE、MBP与HIE脑损伤程度的关系。方法 :用双抗体夹心酶联免疫法测脑脊液中NSE、MBP。结果 :(1)临床分度各组NSE的含量与脑损伤程度一致。 (2 )临床分度各组MBP的含量仅于重度组显著升高。 (3)临床轻、重度患儿CT分度与临床基本一致 ,而临床中度的患儿CT分度与临床分度并不完全一致。 (4)CT分度各组脑脊液中NSE、MBP含量均无差异。结论 :脑脊液中NSE可作为早期判断HIE脑损伤程度的生化指标。MBP增高说明脑损伤严重。生后一周后作头颅CT检查不能准确反映脑损伤程度。     

新生儿缺氧缺血性脑病临床、CT与烯醇酶、髓鞘碱性蛋白的关系

目的：Ｐ探讨ＮＳＥ、ＭＢＰ与ＨＩＥ脑损伤程度的关系。方法：用双抗体夹心酶联免疫法测脑脊液中ＮＳＥ、ＭＢＰ。结果：（１）临床分度各组ＮＳＥ的含量与脑损伤程度一致。（２）临床分度各组ＭＢＰ的含量仅于重度组显著同。（３）临床轻、重度患儿ＣＴ分度与临床基本一致,而临床中度的患儿ＣＴ分度与临床分度并不完全一致。（４）ＣＴ分度各组脑脊液中ＮＳＥ、ＭＢＰ含量均无差异。结论：脑脊液中ＮＳＥ可作为早期判断ＨＩＥ脑损伤程度的生化指标。ＭＢＰ增高说明脑损伤严重。生后一周后作头颅ＣＴ检查不能准确反映脑损伤程度。     

红藻氨酸致癫痫大鼠血清和脑脊液中S100B、CGRP水平的研究

目的 测定大鼠痫性发作后各时间点血清和脑脊液中S100B、降钙素基因相关肽(caleitonin gene related peptide,CGRP)的含量,以探讨这些生化指标在癫痫临床诊治中的应用前景.方法 雄性SD大鼠侧脑室注射红藻氨酸(Kainic acid,KA)建立颞叶癫痫动物模型,在痫性发作后6h、12h、24h、72h、1w抽取血液和脑脊液,用ELISA方法测定血清和脑脊液中S100B、CGRP含量的变化.结果 血清和脑脊液中S100B含量在癫痫发作后6h逐渐增加,在24h达高峰,而血清和脑脊液中CGRP含量在痫样发作后6h逐渐降低,在24h最低.结论 血清和脑脊液中S100B、CGRP水平可作为判断癫痫脑损伤的早期生化指标.     

重型颅脑损伤开颅术后早期颅内压与脑脊液及外周血CRP、D-D的相关性

目的 探讨重型颅脑损伤开颅术后早期颅内压（ICP）与脑脊液及外周血C反应蛋白（CRP）、D二聚体（D-D）的相关性。方法 回顾性分析2015年1月至2016年12月收治的37例重型颅脑损伤的临床资料。开颅术后留置ICP探头持续监测ICP。术后3 d内，每12 h采集脑脊液及外周血标本，检测CRP和D-D水平。结果 ICP>20 mmHg病人血清CRP及D-D、脑脊液CRP及D-D水平均明显高于ICP≤20 mmHg病人（P<0.05）。血清CRP、D-D、脑脊液CRP、D-D与ICP呈明显正相关（P<0.05）。血清CRP、血清D-D、脑脊液CRP、脑脊液D-D对预测各检测点未来12 h内出现ICP>20 mmHg均有可靠价值，曲线下面积分别0.854、0.943、0.870、0.951。脑脊液D-D增高是未来12 h内出现ICP>20 mmHg的独立影响因素（P<0.05）。结论 重型颅脑损伤开颅术后早期ICP与脑脊液及外周血CRP、D-D呈明显正相关，且与脑脊液D-D的关系最密切。     

颅脑外伤后脑脊液促性腺激素释放激素的含量测定

目的探讨颅脑外伤患者脑脊液中促性腺激素释放激素(GnRH)含量变化及临床意义。方法临床收集130例颅脑外伤患者脑脊液标本为实验组,另选取54例健康者脑脊液标本为对照组。应用放射免疫技术测定患者24h、1周及2周脑脊液中GnRH的含量变化。结果测试发现颅脑外伤后GnRH在脑脊液中的含量明显升高,可能与脑损伤程度关系密切。实验组所有脑脊液标本中GnRH含量显著高于健康对照组(P<0.05)。结论颅脑损伤患者脑脊液中GnRH的含量升高,有助于判定脑损伤程度。     

重型颅脑损伤患者血清和脑脊液髓鞘碱性蛋白变化及意义

探讨颅脑损伤患者血清和脑脊液（CSF）中髓鞘碱性蛋白（MBP）含量变化。方法采用酶联免疫吸附法测定了60例重型颅脑损伤患者的血清和CSF中MBP含量。结果患者血清和CSF中MBP含量均增高,其上升水平与脑损伤类型及程度有关。结论同步检测血清和CSF中MBP含量变化,对判断颅脑损伤的程度及类型有一定实用价值。     

颅脑损伤患者血清NSE的含量变化及临床意义

目的动态监测颅脑损伤患者血清神经元特异性烯醇化酶(NSE)的含量变化,并探讨NSE与颅脑损伤程度及其预后之间的关系。方法用酶联免疫测定法检测86例颅脑损伤患者的血清NSE含量,并分析其与颅脑损伤严重程度及患者预后的关系。结果颅脑损伤患者血清NSE水平明显高于对照组(P<0.05);重度颅脑损伤患者血清NSE水平又明显高于中、轻度颅脑损伤者(P<0.05);重度颅脑损伤预后不良者的血清NSE水平则明显高于预后良好者(P<0.05)。结论血清NSE水平与脑损害的严重程度呈正相关,可作为评估颅脑损伤预后的重要指标。     

颅脑损伤患者血清与脑脊液IL-1β及NSE水平的变化及临床意义

目的探讨颅脑损伤患者血清与脑脊液IL-1β及NSE水平的变化及临床意义。方法选取2014-06—2016-01我院收治的96例颅脑损伤患者为研究对象(实验组),选取同期门诊健康者30例为对照组,应用双抗体夹心酶联免疫吸附试验法(ELISA)检测样本IL-1β及NSE的含量,比较实验组发病入院后不同时间点与对照组血清与脑脊液IL-1β及NSE的水平。依据患者入院时的格拉斯哥昏迷量表(GCS)评分将其分为轻度组(n=36)、中度组(n=32)和重度组(n=28),对比各组患者血清与脑脊液IL-1β及NSE水平的变化。结果观察组血清及脑脊液IL-1β及NSE水平均明显高于对照组(P0.05);发病入院1d、3d,颅脑损伤患者血清及脑脊液IL-1β及NSE水平均呈升高趋势(P0.05),且在发病后第3天达到高峰;发病入院后第7天,血清及脑脊液IL-1β及NSE水平均轻微下降。轻度、中度、重度组血清及脑脊液IL-1β及NSE水平均明显高于对照组,且随着病情程度的加重,血清及脑脊液IL-1β及NSE水平均呈升高趋势,血清及脑脊液IL-1β及NSE水平与患者病情程度具有明显相关性。脑脊液中IL-1β及NSE水平均高于血清(P0.05)。结论颅脑损伤后患者血清及脑脊液IL-1β及NSE水平可反映颅脑损伤程度,可作为判断颅脑损伤患者预后的敏感指标。     

重型颅脑损伤后白细胞介素—6变化及其意义

目的 研究脑损伤后白细胞介素－６（ＩＬ－６）的变化及对急性应期的作用。方法 用酶联免疫法（ＥＬＩＳＡ）和酶标仪测定创伤性脑损伤后脑脊液和血清ＩＬ－６的连续变化及测定急性反应蛋白的变化。结果 正常对照组脑脊液中均未能检测到ＩＬ－６,重型创伤脑损伤后脑脊液和血清ＩＬ－６均升高,且脑脊液ＩＬ－６较血清的ＩＬ－６明显升高。在血脑屏障功能严重障碍时脑脊液的ＩＬ－６与血清的ＩＬ－６相关。血清ＩＬ－６的最大值与     

不同GCS评分颅脑损伤患者血清及CSF中tau及Aβ42水平及其临床意义

目的 观察颅脑损伤患者血清及CSF中tau及Aβ42水平的变化及其意义。方法 对本院2014年7月～2016年4月收入的60例颅脑损伤患者进行血清及CSF中tau蛋白及Aβ42的表达水平检测,分析其与患者损伤程度及预后的关系。结果 和对照组相比,试验A组和B组颅脑损伤患者血清及CSF中tau蛋白水平和Aβ42水平显著升高。不同时间GCS A组患者血清及CSF中tau蛋白水平和Aβ42水平显著高于GCS B组(P<0.05)。与GCS A组相比,GCS B组GOS评分为1～3分的患者比例显著降低,GOS评分为4～5分的患者比例显著增加(P<0.05)。结论 tau蛋白水平、Aβ42表达水平与颅脑损伤密切相关,可作为颅脑损伤患者预后的重要评价指标,而且Aβ42在重型创伤性颅脑损伤患者伤后认知功能障碍的病理生理机制中可能发挥着重要作用。     

Serum and urine nitrate and nitrite are not reliable indicators of intrathecal nitric oxide production in acute brain injury

This study examined the correlation between nitric oxide (NO) metabolites in the three major body fluid compartments and assessed performance of newly described vanadium-based assay for simultaneous detection of nitrite and nitrate (NO(x)) in human samples. Vanadium reduces nitrate to nitrite, which can be measured after a colorimetric reaction with Griess reagents.Cisternal cerebro spinal fluid (CSF), serum and urine samples from 10 patients with acute brain injury (ABI) were compared to control subjects. Significantly higher CSF NO(x) levels were found in brain injury patients compared to control patients (19.7+/-13.7 vs. 6.5+/-2.3 microM; p=0.01), which persisted for 10-day period of observation. The serum and urine levels of NO(x) on admission were not statistically different (42.8+/-28.2 microM; 584.1+/-337.8 micromol/g Cr, respectively) from controls (36.8+/-14.8 microM; 819.7+/-356.0 micromol/g Cr), but tended to decrease during the disease course reaching the lowest level on day 6 (serum: 19.3+/-8.4 microM, urine: 300.4+/-111.9 micromol/g Cr). CSF levels of NO(x) correlated moderately with those in serum (p=0.001, R=0.5). Serum NO(x) concentrations correlated weakly with urine levels (p=0.04, R=0.3). There was no significant correlation between CSF NO(x) and urine NO(x) levels.In conclusion, patients suffering brain injury had increased NO(x) concentrations in CSF, which remained independent from other body fluid compartments. Serum and urinary NO(x) levels cannot be used as a reliable index to assess intrathecal NO production.     

格林—巴利综合征患者血清和脑脊液中的抗硫脂抗体

探讨抗硫脂抗体与格林－巴利综合征（ＧＢＳ）的关系。方法采用固相酶联免疫吸附法对急性期ＧＢＳ患者血清和脑脊液（ＣＳＦ）中抗硫脂ＩｇＧ和ＩｇＭ抗体进行检测。结果ＧＢＳ患者血清和ＣＳＦ中抗硫脂ＩｇＧ及ＩｇＭ抗体的阳性率均明显高于正常对照组；血清中抗硫脂ＩｇＭ抗体滴度与标本收集时患者发病天数呈负相关（Ｐ＜０．０５），而血清中抗硫脂ＩｇＧ抗体滴度与临床分级（Ｐ＜０．０１）、ＣＳＦ中抗硫脂ＩｇＧ抗体滴度（Ｐ＜０．０１）呈正相关；血清中抗硫脂ＩｇＧ或ＩｇＭ阳性的ＧＢＳ患者，体检时有不同程度的感觉障碍患者为５６％，而血清中抗硫脂抗体阴性患者仅为１６％，两者之间差异有显著意义（Ｐ＜０．０５）。结论抗硫脂抗体可能在ＧＢＳ的病理过程中起重要作用     

Experimental axonal injury triggers interleukin-6 mRNA, protein synthesis and release into cerebrospinal fluid.

Diffuse axonal injury is a frequent pathologic sequel of head trauma, which, despite its devastating consequences for the patients, remains to be fully elucidated. Here we studied the release of interleukin-6 (IL-6) into CSF and serum, as well as the expression of IL-6 messenger ribonucleic acid (mRNA) and protein in a weight drop model of axonal injury in the rat. The IL-6 activity was elevated in CSF within 1 hour and peaked between 2 and 4 hours, reaching maximal values of 82,108 pg/mL, and returned to control values after 24 hours. In serum, the levels of IL-6 remained below increased CSF levels and did not exceed 393 pg/mL. In situ hybridization demonstrated augmented IL-6 mRNA expression in several regions including cortical pyramidal cells, neurons in thalamic nuclei, and macrophages in the basal subarachnoid spaces. A weak constitutive expression of IL-6 protein was shown by immunohistochemical study in control brain. After injury, IL-6 increased at 1 hour and remained elevated through the first 24 hours, returning to normal afterward. Most cells producing IL-6 were cortical, thalamic, and hippocampal neurons as confirmed by staining for the neuronal marker NeuN. These results extend our previous studies showing IL-6 production in the cerebrospinal fluid of patients with severe head trauma and demonstrate that neurons are the main source of IL-6 after experimental axonal injury.     

血清、脑脊液中S-100B在颅脑外伤损伤程度中的诊断意义

目的 探讨血清、脑脊液中S-100B与颅脑外伤(traumatic brain injury,TBI)损伤程度的关系.方法 选择45例TBI患者按格拉斯哥昏迷分级(GCS评分)分轻、中、重三组(病例组),采用酶联免疫吸附法(EHSA)测定TBI患者伤后第1、3、5、7天血清及脑脊液S-100B水平,并选择20例与病例组相匹配的疝或静脉曲张手术病人以及健康体检自愿者的血清、脑脊液作为对照组,分析血清及脑脊液S-100B水平与TBI损伤程度的相关性.结果 病例组血清、脑脊液S-100B水平较对照组明显升高(P ＜0.01;P ＜0.01);TBI患者GCS评分与血清及脑脊液S-100B水平比较呈负相关(r=-0.893,P＜0.01;r=-0.947,P＜0.01);血清、脑脊液S-100B在不同程度TBI间比较差异显著(P＜0.01);病例组血清和CSF中S-100B水平比较呈正相关;结论 血清、脑脊液S-100B测定均可作为判断TBI程度的指标,且各有特点.     

Folate and monoamine metabolism in epilepsy.

In 27 drug-treated epileptics there was a significant fall in serum, red cell and CSF folate levels compared with 15 untreated epileptics and 22 neurological controls. The 3 folate parameters were positively correlated with each other and negatively correlated with serum phenobarbitone, diphenylhydantoin and primidone. There was also a significant elevation of CSF 5-hydroxyindoleacetic acid (5HIAA) in the drug-treated epileptics; but this was not seen until "therapeutic" serum levels of phenobarbitone and diphenylhydantoin had been achieved and was most marked in clinically intoxicated patients. Similar trends were observed in CSF homovanillic acid (HVA). CSF 5HIAA and HVA were positively correlated with each other, especially in the drug-treated patients, in whom both amine metabolites were also negatively correlated with CSF folate. A possible relationship between folate and monoamine metabolism is discussed with particular reference to the antiepileptic and toxic effects of phenobarbitone, diphenylhydantoin and primidone.     

Relationships between glutamate and monoamine metabolites in cerebrospinal fluid and serum in healthy volunteers

The concentrations of homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), 4-hydroxy-3-methoxyphenylglycol (HMPG), and glutamate were determined in cerebrospinal fluid (CSF) and serum in 10 healthy volunteers. The monoamine metabolites were measured by mass fragmentography and the glutamate by high-performance liquid chromatography. The level of glutamate in CSF was low (0.34 +/- 0.14 nmol/ml) in comparison with previously published values. The concentrations of monoamine metabolites in CSF were in close agreement with earlier findings. There were negative correlations between the concentrations of HVA (r = -0.82, p less than 0.01) and 5-HIAA (r = -0.77, p less than 0.01) and glutamate in CSF, but not in serum. The serum levels of HMPG and glutamate were negatively correlated (r = -0.95, p less than 0.001), but not the CSF levels. The HMPG levels in serum and CSF were positively correlated (r = 0.94, p less than 0.001), but not the HVA and the 5-HIAA levels. The serum and CSF levels of glutamate were positively correlated (r = 0.67, p less than 0.05). The results indicate relationships among the metabolism of dopamine, serotonin, and glutamate in the brain and between the metabolism of noradrenaline and glutamate in peripheral tissue.     

血清TGF-β、VTN水平与成人脑胶质瘤病理分级及预后的关系

目的 探讨外周血转化生长因子-β（TGF-β）、玻连蛋白（VTN）水平与成人脑胶质瘤病理分级及预后的关系。方法 选取2015年1月至2016年1月手术治疗的胶质瘤98例（高级别53例，低级别45例）和同期健康体检者50例（对照组）为研究对象，术前1 d、术后 7 d检测血清TGF-β、VTN水平。术后随访3年。结果 术前1 d胶质瘤病人血清TGF-β、VTN水平均显著高于对照组（P<0.05），而且术前1 d血清TGF-β（r=0.734，P<0.05）、VTN（r=0.717，P<0.05）水平与胶质瘤病理分级呈正相关。术后3年，98例胶质瘤中，死亡69例，存活29例；存活病人术前血清TGF-β、VTN水平均显著低于死亡病人（P<0.05）；ROC曲线分析结果显示术前1 d血清TGF-β、VTN水平预测术后3年病人死亡风险的最佳截断值分别为350.39 pg/ml、86.12 μg/ml。结论 胶质瘤病人血清TGF-β、VTN水平与肿瘤病理分级正相关，而且血清TGF-β、VTN水平升高提示病人预后不良。     

General anesthesia and the ketogenic diet: clinical experience in nine patients

PURPOSE: To determine if children actively on the ketogenic diet (KD) can safely undergo general anesthesia (GA) for surgical procedures. METHODS: The records of children treated with the KD at Children's Hospital (Boston, Massachusetts) from 1995 to the present were reviewed. The charts of children who had received GA while on the diet were evaluated with regard to demographics, procedure information, anesthesia records, blood chemistries, and perioperative course. Of 71 children on the KD during the period of the study, nine (12.7%) had procedures requiring GA while on the diet. RESULTS: Nine children received GA for surgical procedures ranging from central line placement to hemispherectomy while on the KD. At the time of GA, the children ranged from age 1 to 6 years, and had been on the KD for 2-60 months. The patients received carbohydrate-free intravenous solutions perioperatively. Anesthesia duration ranged from 20 min to 11.5 h; for longer procedures, serum pH, glucose, and electrolyte levels were monitored. Serum glucose levels remained stable in all patients, but serum pH typically decreased; the largest reduction was to 7.16. In three procedures, patients received intravenous bicarbonate because of level of acidosis. There were no perioperative complications. CONCLUSIONS: Children on the KD can safely undergo GA for surgical procedures. Although serum glucose levels appear to remain stable, serum pH or bicarbonate levels should be monitored because of the risk of metabolic acidosis.