摘要
目的通过观察高压氧(hyperbaric oxygen,HBO)治疗对创伤性颅脑损伤(traumatic brain injury,TBI)患者外周血调节性T细胞(regulatory T cell,Treg)比例、血清神经元烯醇化酶(neuron specific enolase,NSE)及超敏C反应蛋白(hypersensetive C-reactive protein,Hs-CRP)的影响,探讨HBO治疗促进TBI患者神经功能恢复的作用机制。方法重症TBI患者68例,签署知情同意书后,将患者按治疗方式分为对照组(30例)和HBO组(38例),对照组给予急诊去骨瓣减压+颅内血肿清除术,术后吸氧、止血、降低颅内压、改善脑循环、改善脑代谢、营养神经等常规治疗;HBO组在对照组的基础上给予HBO治疗。在治疗前、治疗7 d及14 d后进行格拉斯哥昏迷评分(Glasgow coma scale,GCS)及外周血NSE、Hs-CRP及Treg的测定。结果HBO组治疗14 d后GCS评分明显高于对照组,差异有统计学意义(HBO组9.7±2.8,对照组7.9±2.2,P<0.05)。HBO组治疗7 d及14 d后,血清Hs-CRP表达[7 d,(1.45±0.44)ng/ml,14 d,(0.99±0.39)ng/ml]、CD4^+CD25^+T细胞比例[7 d,(10.8±3.7)%,14 d,(7.1±3.0)%]及CD4^+CD25high^+CD127dimT细胞比例[7 d,(6.0±2.6)%,14 d,(3.5±2.2)%]均明显低于对照组[7 d,(1.78±0.52)ng/ml,14 d,(1.30±0.50)ng/ml;7 d,(12.9±4.7)%,14 d,(9.8±3.5)%;7 d,(7.4±2.7)%,14 d,(5.2±2.2)%],差异有统计学意义(P<0.05)。血清NSE表达仅在HBO治疗14 d后,2组比较差异有统计学意义(HBO组12.67±2.84,对照组16.3±2.67,P<0.05)。结论HBO治疗明显促进TBI患者神经功能的恢复。HBO治疗可能通过改变外周血Treg细胞比例而减轻TBI后的神经炎性反应,进而减轻神经元损伤,促进神经功能恢复。
Objective To explore the mechanism of hyperbaric oxygen(HBO)therapy on improving neurological function recovery of traumatic brain injury(TBI)patients through observing the effects of HBO on peripheral blood regulatory T cell(Treg)ratio,neuron specific enolase(NSE),and hypersensitive C-reactive protein(Hs-CRP)in TBI patients.Methods After signing the informed consent,68 patients with severe TBI were divided into the control group(30 cases)and the HBO group(38 cases).The patients in the control group were treated with emergency decompression of bone flap+intracranial hematoma removal,postoperative oxygen inhalation,hemostasis,reduction of intracranial pressure,improvement of brain circulation,and brain metabolism,neurotrophic and other conventional treatments.The HBO group patients were treated with HBO on the basis of the treatments of the control group.The score of the Glasgow coma scale(GCS)and the levels of peripheral blood NSE,Hs-CRP,and Treg were measured before and after treatment for 7 d and 14 d.Results After 14 days of treatment,the GCS score of the HBO group was significantly higher than that of the control group,with statistically significant difference (9.7±2.8 in the HBO group and 7.9±2.2 in the control group,P<0.05).After treatment 7 d and 14 d,the serum HS-CRP expression[7 d,(1.45±0.44)ng/ml;14 d,(0.99±0.39)ng/ml],CD4^+CD25^+T cells[7 d,(10.8±3.7)%;14 d,(7.1±3.0)%]and CD4^+CD25high^+CD127dimT cells[7 d,(6.0±2.6)%;14 d,(3.5±2.2)%]were significantly lower than those of the control group HS-CRP,(1.78±0.52)ng/ml on 14 d,(1.30±0.50)ng/ml on 14 d;CD4^+CD25^+T,(12.9±4.7)%on 7 d and(9.8±3.5)%on 14 d;CD4^+CD25high^+CD127dimT,(7.4±2.7)%on 7 d and(5.2±2.2)%on 14 d,the differences were statistically significant(P<0.05).Only 14 days after HBO treatment,the difference of the serum NSE expression between the two groups was statistically significant(the HBO group:12.67±2.84,the control group:16.3±2.67,P<0.05).Conclusion HBO treatment can significantly promote the recovery of neurological function in TBI patients.HBO therapy may reduce the neuroinflammatory response after TBI by changing the proportion of Treg cells in peripheral blood,thus reducing neuron damage and promoting neurological function recovery.
作者
高会新
时明慧
张帅
李轩
杨晶
刘雪华
张涵
Gao Huixin;Shi Minghui;Zhang Shuai;Li Xuan;Yang Jing;Liu Xuehua;Zhang Han(Department of Hyperbaric Oxygen,Miyun Teaching Hospital,Capital Medical University,Beijing 101500,China)
出处
《中华航海医学与高气压医学杂志》
CAS
CSCD
2020年第4期439-443,共5页
Chinese Journal of Nautical Medicine and Hyperbaric Medicine
基金
首都医科大学本科生科研创新项目(XSKY20191734)。
关键词
高压氧
颅脑损伤
调节性T细胞
Hyperbaric oxygen
Craniocerebral injury
Regulatory T cell
