七叶皂苷钠对重型颅脑创伤患者脑脊液肿瘤坏死因子-α及白细胞介素-6表达的影响

摘要

目的 观察七叶皂苷钠对重型颅脑创伤患者脑脊液肿瘤坏死因子-α (TNF-α)及白细胞介素-6(IL-6)表达的影响,探讨其临床意义.方法 将73例重型颅脑创伤患者按入院先后顺序分为对照组(36例)及治疗组(37例).对照组采用西医常规治疗,治疗组在西医治疗的基础上加用七叶皂苷钠每日20 mg静脉滴注,连续治疗10d.采用放射免疫法测定两组患者不同时间点脑脊液中TNF-α及IL-6的含量,同时监测患者颅内压(ICP)变化,并在伤后6个月根据格拉斯哥预后评分(G0S)判断预后.结果 治疗组治疗前及伤后1d脑脊液TNF-α及IL-6水平与对照组无明显差异(均P＞ 0.05),伤后3、7及14d均较对照组明显降低(P＜0.05或P＜0.01).在治疗前及伤后1d,治疗组ICP与对照组比较无明显差异(均P＞ 0.05),在伤后3、7、14 d均较对照组明显降低(均P＜ 0.01);治疗组病死率低于对照组(27.03％比38.89％,P＜0.05),预后改善明显.结论 七叶皂苷钠可明显降低重型颅脑创伤患者脑脊液TNF-α及IL-6表达水平,降低ICP,促进神经功能恢复,改善预后.%Objective To observe the effect of sodium aescinate on the expressions of tumor necrosis factor- a (TNF-a) and interleukin-6 (IL-6) in cerebrospinal fluid (CSF) of patients with severe traumatic brain injury (sTBI), and investigate its clinical significance. Methods All 73 patients of sTBI were randomly divided into control group (36 cases) and treatment group (37 cases). Both groups were treated with conventional western medicine, while in the treatment group, the sodium aescinate daily 20 mg was additionally given for consecutive 10 days. The expression levels of TNF-a and IL-6 in CSF were measured by radioimmunoassay (RIA) method at different time points. In the mean time, the intracranial pressure (ICP) of all patients was measured. According to Glasgow outcome scale (GOS), the prognosis was evaluated after 6 months of injury. Results Compared with control group, in the treatment group, the expression levels of TNF- a and IL-6 in CSF had no significant difference (all P> 0.05) before the treatment and on the 1st day after injury, but significantly decreased on the 3rd , 7th and 14th day after injury (P < 0.05 or P < 0.01). Compared with control group, before the treatment and on the 1st day after injury, the level of ICP in treatment group had no significant difference (both P> 0.05), but significantly decreased on the 3rd, 7th and 14th day after injury in the treatment group (all P< 0.01). The mortality of treatment group was lower than that of control group (27.03% vs. 38.89%, P< 0.05), and the prognosis in treatment group was improved obviously. Conclusions In the patients with sTBI, sodium aescinate is an effective therapy. It can protect brain tissue through obviously decreasing ICP and the expression levels of TNF- a and IL-6 in CSF, and can improve the nervous functional recovery and prognosis.