脑出血后不同时间脑脊液中可溶性白细胞介素6受体的变化

背景在脑血管病脑损伤中有许多细胞因子的参与,而白细胞介素6(interleukin-6,IL-6)被认为在中枢神经系统中具有神经保护和神经营养作用,而脑出血急性期脑脊液可溶性IL-6受体(solubleinterleukin-6receptor,sIL-6R)的研究国内外报道较少.目的研究脑出血急性期脑脊液中sIL-6R变化与继发性脑损伤的关系.设计病例对照研究.单位暨南大学医学院第五附属医院检验科、神经外科、神经内科联合进行课题研究.对象从1999-01/2003-12收治的脑出血患者627例中,选择经临床诊断和CT证实的自发性脑出血后48h内入院的患者,并排除创伤性脑出血和其他脑血管疾病,符合以上标准的32例患者作为研究对象(脑出血组),其中脑实质出血破入脑室者23例,单纯脑实质出血者7例,单纯脑室出血2例.13例同期住院的非神经系统疾病就诊者为对照组.方法患者于入院后2d内腰穿取脑脊液2 mL离心沉淀取上清液放-80℃超低温冰箱保存待测,12例患者出血后第1,2,3,5,10～13天进行动态观察.采用酶联免疫吸附试验(ELISA)测定对照组和脑出血患者脑脊液中sIL-6R含量.主要观察指标对照组和脑出血患者脑脊液中sIL-6R含量.结果13例对照组和32例脑出血急性期患者脑脊液中sIL-6R含量分别为(380.54±93.05)ng/L,(1220.18±878.71)ng/L,两者之间差别有显著意义(t'=5.332 3,P＜0.05).脑实质出血破入脑室者sIL-6R水平[(1350.79±762.63)ng/L]显著高于单纯脑实质出血者[(609.21±398.99)ng/L],差异有显著性意义(t=2.4623,P＜0.05).脑出血第1天时sIL-6R水平已达最高(1 503.01±775.13)ng/L,此后仍维持在较高水平.结论脑出血急性期患者sIL-6R含量显著升高,与继发性脑损伤程度和炎症反应有关.

Change of soluble interleukin 6 receptor in cerebral spinal fluid of different time after cerebral hemorrhage

BACKGROUND: There are many cell factors involved in cerebrovascular diseases and cerebral damages. Interleukin 6(IL-6) has been widely believed that it can protect and nourish nerves in central nervous system. However, there are few literatures at home and abroad regarding soluble interleukin-6 receptor(sIL-6R) in cerebral spinal fluid in the acute stage of cerebral hemorrhage.OBJECTIVE: To explore the change of sIL-6R in cerebral spinal fluid in acute stage of cerebral hemorrhage as well as its relationship with secondary cerebral injury.DESIGN: Case control study.SETTING: Department of dicimasia, neurosurgery and neurology, the Fifth Affiliated Hospital of Medical College of Jinan University.PARTICIPANTS: There were 627 patients with cerebral hemorrhage treated during January 1999 to December 2003. Selective criteria: Patients with spontaneous cerebral hemorrhage confirmed by clinical diagnosis and CT examination and admitted into hospital within 48 hours; traumatic cerebral hemorrhage and other cerebrovascular diseases have been excluded. A total of 32 patients met the above criteria were chosen as hemorrhage group, among which there were 23 patients with hemorrhage of cerebral substance breaking into ventricle, 7 patients with simply cerebral substance hemorrhage and 2 patients with simply ventricular hemorrhage. Thirteen patients admitted into hospital with non-nervous system diseases were selected as control group.METHODS: 2 mL cerebral spinal fluid was collected from patients by epidural puncture within 2 days after admission and centrifugated and deposited to collect supernate. The specimens were put into -80 ℃ ultra low temperature freezer to store. Dynamic observation of 12 patients was conducted in the 1st, 2nd, 3rd, 5th and 10th to 13th day. ELISA was used to assay the content of sIL-6R in cerebral spinal fluid of control group and hemorrhage patients.MAIN OUTCOME MEASURES: The content of sIL-6R in cerebral spinal fluid of patients in both control group and hemorrhage group.RESULTS: The content of sIL-6R in cerebral spinal fluid of 13 patients in control group and 32 patients in acute stage of cerebral hemorrhage was(380.54 ± 93.05) ng /L, (1 220. 18 ± 878.71) ng /L respectively. There was significant difference between two groups ( t' = 5. 332 3, P ＜ 0. 05) .The sIL-6R in patients with hemorrhage breaking into ventricles from cerebral substance[ (1 350.79 ± 762.63) ng /L] was much higher than that of simply cerebral substance hemorrhage[ (609.21 ± 398.99) ng /L] with significant difference between two groups ( t = 2. 462 3, P ＜ 0. 05 ). In the first day after cerebral hemorrhage, the level of sIL-6R already reached to peak(1 503.01 ± 775.13) ng/L and maintained high level after this.CONCLUSION: The content of sIL-6R greatly increases in the acute stage of cerebral hemorrhage which is related to the degree of secondary cerebral injury and inflammatory reactions.