急性颅脑损伤后血高迁移率蛋白-1及中性粒细胞激活肽-78的变化

目的 研究急性颅脑损伤后血中高迁移率蛋白-1(HMGB1)和中性粒细胞激活肽-78(ENA-78)的动态变化及其与继发性脑水肿的关系.方法 采用酶联免疫吸附法(ELISA)检测HMGB1和ENA-78血中含量,回顾性分析110例急性颅脑损伤住院患者伤后12 h内、伤后第3,5d血中HMGB1和ENA-78含量,采用t检验并结合临床表现、影像学检查及格拉斯哥预后评分(GOS)进行比较分析.结果 急性颅脑损伤患者伤后早期12h内血中HMGB1和ENA-78含量随着格拉斯哥昏迷评分(GCS)下降均有不同程度的升高.颅脑损伤越严重,HMGB1和ENA-78升高越明显,脑水肿程度越重,并且脑水肿高峰持续时间越长(P＜0.01).颅脑损伤早期血中HMGB1和ENA-78含量与脑水肿严重程度(r=0.69,0.62,P＜0.01)和脑水肿高峰持续时间呈正相关(r =0.70,0.65,P＜0.01).此外,不同GOS组之间HMGB1和ENA-78差异亦有统计学意义,其中预后不良组血中HMGB1和ENA-78含量在伤后5d内持续升高,而且显著高于预后良好组和健康对照组(P＜0.01或P＜0.05).同时急性颅脑损伤后血中HMGB1与ENA-78的含量呈正相关(r=0.68,P＜0.01).结论 急性颅脑损伤后血中HMGB1和ENA-78的变化与继发性脑水肿存在一定的相关性.

Changes of.serum high mobility group box-1 and epithelial neutrophil-activing peptide-78 in patients with acute brain injury

Objective To investigate the dynamic changes of serum high mobility group box-1 (HMGB1)and epithelial neutrophil-activing peptide-78(ENA-78)associated with secondary brain edema in patients following acute brain injury.Methods The serum HMGB1 and ENA-78 in 110 patients with acute brain injury were determined by using enzyme-linked immunosorbent assay(ELISA)12 hours,3 days and the 5 days after acute brain injury.The outcomes were analyzed by t-test and estimated well with clinical symptoms,imaging data and Glasgow Outcome Scale(GOS)in combination of.Results The levels of HMGB1 and ENA-78 increased significantly with lowering the score of GCS 12 hours after acute brain injury.The more severity of acute brain injury resulted in more production of HMGB1 and ENA-78 and longer period of persisted and peaked brain edema(all P ＜0.01).HMGB1 levels had positive correlation with severity and persistence of brain edema(r =0.69,P ＜0.01 and r =0.70,P ＜0.01).ENA-78 levels had positive correlation with severity and persistence of brain edema(r =0.62,P ＜ 0.01 and r =0.65,P ＜ 0.01).Furthermore,there were statistical differences in HMGB1 and ENA-78 levels between different GOS groups.Compared with good outcome group and normal control group,the HMGB1 and ENA-78 levels in poor outcome group persistently increased and were higher within 5 days after brain injury(P ＜ 0.01 or P ＜0.05).There was a correlation between serum HMGB1 and ENA-78 levels in patients with acute brain injuries(r =0.68,P ＜ 0.01).Conclusions The changes of serum HMGB1 and ENA-78 levels were closely associated with secondary brain edema in patients following acute brain injury.