摘要
目的:观察西宁地区（平均海拔2300 m）高血压脑出血手术患者严重程度与炎症反应变化特征。方法:将西宁地区106例高血压脑出血手术患者根据格拉斯哥昏迷评分（GCS）分为3组，中型组（GCS评分在9~12分，25例）、重型组（GCS评分在6~8分，51例）、极重型组（GCS评分在3~5分，30例），分别抽取术前、术后第1天、术后第3天、术后第7天静脉血并行血常规：白介素-6（IL-6）、降钙素原（PCT）、C反应蛋白（CRP）、白细胞（WBC）、中性粒细胞（NEUT）、淋巴细胞（LY）、血小板（PLT）及NOD样受体热蛋白结构域相关蛋白3（NLRP3）炎症小体指标的检测；对不同GCS评分组患者及其不同时间点间炎症指标的变化进行比较。结果:不同GCS评分组患者炎症反应指标的比较：术前，与中型组比较，重型组IL-6、WBC、NEUT均升高，极重型组PCT升高，而重型组与极重型组NLRP3均降低，与重型组比较，极重型组PCT升高，差异均有统计学意义（P＜0.05）；术后第1天，与中型组比较，重型组IL-6升高，极重型组PCT升高，差异有统计学意义（P＜0.05）；术后第3天，与中型组比较，重型组WBC、NEUT升高，极重型组NLRP3炎症小体偏低，与重型组比较，极重型组WBC、NEUT降低，差异有统计学意义（P＜0.05）；术后第7天，与中型组比较，重型组WBC、NEUT升高，差异均有统计学意义（P＜0.05）；其余炎性指标比较，差异均无统计学意义（P＞0.05）。3组不同时间点患者炎症反应指标的比较：与术前比较，术后第1天3组IL-6、PCT、CRP、NLRP3均升高，术后第3天CRP均升高，而中度组NLRP3明显下降，重度组PCT、NLRP3均升高，极重组IL-6、NLRP3均升高，术后第7天CRP均持续升高，而重度组PCT仍持续升高，自术后第1、3天PLT均明显下降，术后第1、3天重度组与极重组LY均明显下降，而第3、7天中型组LY均明显下降；与术后第1天比较，术后第3天中型组WBC、NEUT、NLRP3均下降，术后第7天中型组IL-6、CRP、WBC、NEUT、NLRP3明显下降，而术后第3、7天重型组与极重型组IL-6、WBC、NEUT、NLRP3均明显下降；与术后第3天比较，术后第7天中型组CRP下降，重型组IL-6、CRP、NLRP3均明显下降，极重型组IL-6、CRP均明显下降，术后第3、7天3组PLT均明显上升，差异均有统计学意义（P＜0.05）；其余炎性指标比较，差异均无统计学意义（P＞0.05）。结论:在高海拔地区，高血压脑出血手术患者炎症反应指标在术后第1天均明显升高，重型组更为明显，炎症指标自术后第3天逐渐下降；NLRP3炎症小体在中型与重型组中升高更为突出，若能早期干预炎症反应可能改善患者预后。
Abstract
Objective:To observe the severity and inflammatory response changes in patients with hypertensive intracerebral hemorrhage in the Xining area (average altitude: 2300 m).Methods:A total of 106 patients with hypertensive intracerebral hemorrhage in the Xining area were divided into three groups according to the GCS score (moderate, severe and extremely severe). Venous blood samples were collected before operation, on the first, third and seventh day after operation, and blood routine, procalcitonin, interleukin-6, C-reactive protein and NLRP3 inflammatory body indexes were monitored. The changes of inflammatory response in three groups at different time points were studied and compared.Results:Comparison of inflammatory response indexes in different GCS groups: Before surgery, compared with moderate group, IL-6, WBC and NEUT were increased in severe group (P＜0.05), and PCT was increased in extremely severe group (P＜0.05), but NLRP3 was lower in severe group and extremely severe group (P＜0.05). On day 1 after surgery, IL-6 in the severe group was increased (P＜0.05), and PCT in the extremely severe group was increased (P＜0.05). On the 3rd day after surgery, WBC and NEUT in the severe group were higher than those in the moderate group (P＜0.05), and NLRP3 inflammatory bodies in the extremely severe group were lower (P＜0.05), and WBC and NEUT in the extremely severe group were higher than those in the severe group (P＜0.05). On the 7th day after surgery, WBC and NEUT in the severe group were higher than those in the moderate group (P＜0.05), but other inflammatory indexes did not show any differences. The comparison of inflammatory response indexes of patients in three groups at different time points: Compared with the preoperative results, IL-6, PCT, CRP and NLRP3 were increased in the three groups on day 1 after surgery (P＜0.05), CRP was increased on day 3 after surgery (P＜0.05), while NLRP3 was decreased significantly in the moderate group (P＜0.05), and PCT and NLRP3 were increased in the severe group (P＜0.05). Polar recombination IL-6 and NLRP3 were increased (P＜0.05), and CRP was increased continuously on the 7th day after surgery (P＜0.05), while PCT was still increased continuously in the severe group (P＜0.05), and PLT was decreased significantly on the 1st and 3rd day after surgery (P＜0.05). LY in the severe group and polar recombination group was significantly decreased on day 1 and 3 after surgery (P＜0.05), while LY in the moderate group was significantly decreased on day 3 and 7 after surgery (P＜0.05). Compared with day 1 after surgery, WBC, NEUT and NLRP3 in the moderate group were decreased on day 3 after surgery (P＜0.05), while IL-6, CRP, WBC, NEUT and NLRP3 in the moderate group were decreased significantly on day 7 after surgery (P＜0.05). On day 3 and 7 after surgery, IL-6, WBC, NEUT and NLRP3 in severe and extremely severe groups were significantly decreased (P＜0.05). Compared with day 3 after surgery, CRP in the moderate group decreased (P＜0.05), IL-6, CRP and NLRP3 in the severe group decreased significantly (P＜0.05), IL-6 and CRP in the extremely severe group decreased significantly (P＜0.05), and PLT in the three groups increased significantly (P＜0.05) on day 3 and 7 after surgery. There was no difference in other inflammatory markers.Conclusion:In the high altitude area, the inflammatory response indexes of patients undergoing surgery for hypertensive intracerebral hemorrhage increase significantly on the first day after surgery.The inflammatory response indexes are more obvious in the severe group, and gradually decrease from the third day after surgery. The increase of NLRP3 inflammasome is more prominent in the moderate and severe groups, and early intervention of inflammatory response may improve the prognosis of patients.
基金项目
青海省科技厅项目(2019-ZJ-7080)
中华国际医学交流基金会项目(Z-2018-35-2101)
万方数据