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[摘要] 目的 观察外源性生长抑素对脑出血患者血清炎性介质表达的影响,探讨其在脑出血患者发挥拮抗炎性损伤的作用及机制。方法 60例脑出血患者随机分为治疗组及干预组,患者治疗前检测血清生长抑素(SS)及TNF-α、IL-6及IL-10表达水平,并与30例健康人对照组比较,治疗组给予生长抑素2.5μg/h,1周后观察治疗组及干预组TNF-α、IL-6及IL-10表达水平差异。结果 治疗前对照组血清生长抑素、TNF-α、IL-6及IL-10表达水平低于治疗组及干预组,治疗组及干预组血清TNF-α、IL-6及IL-10表达水平无差异,治疗1周后,治疗组血清TNF-α、IL-6水平高于干预组,IL-10表达水平低于干预组。结论 脑出血患者生长抑素及炎症介质高表达,外源性生长抑素能够抑制炎性介质的过度释放,减轻炎症反应。
[关键词] 生长抑素;脑出血;肿瘤坏死因子α;白细胞介素6;白细胞介素10
[中图分类号] R743.34[文献标识码] A[文章编号] 1673-9701(2009)36-06-03
Exogenous Somatostatin on Serum Inflammatory Mediator Expression in Patients with Cerebral Hemorrhage
WANG JingzhongZHANG Yubin
Department of Special Wards,the First People’s Hospital of Shangqiu City,Shangqiu 476100,China
[Abstract] Objective To observe the effect of exogenous somatostatinon serum inflammatory mediator expression in patients with cerebral hemorrhage and its antagonistic role and mechanism of inflammatory injury in cerebral hemorrhage. Methods Sixty patients with cerebral hemorrhage were randomly divided into therapeutic groupand intervention group,and 30 healthy adults were served as control group. Before treatment,the somatostatin level,tumor necrosis factor α(TNF-α),interleukin 6(IL-6) and interleukin10(IL-10)were detected,the therapeutic group was given somatostatin 2.5μg/h,and the levels of TNF-α,IL-6 and IL-10 were compared between the therapeutic group and the intervention group after one week treatment. Results Before treatment,the levels of TNF-α,IL-6 and IL-10 were lower in the control group than those in the therapeutic group and the intervention group,there was no difference in the levels of somatostatin,TNF-α,IL-6 and IL-10 between the therapeutic group and the intervention group,and after one week treatment,the levels of TNF-α and IL-6 were higher and the IL10 level was lower in the therapeutic group compared withthe intervention group. Conclusion Exogenous somatostatin can inhibit excessive release of inflammatory mediators.
[Key words] Somatostatin;Cerebral hemorrhage;Tumor necrosis factor;Interleukin 6;Interleukin 10
脑出血是临床常见中枢神经系统疾病,生长抑素是神经组织释放的内源性激素,在中枢神经系统病变时,其表达水平常发生变化,发挥其对组织器官的保护作用,有研究显示[1],脑出血后继发的炎性介质的释放是脑组织及其它器官系统继发性损伤的机制之一,中枢系统疾病时生长抑素的释放是集体自我保护的机制,外源性生长抑素在脑出血时对机体的影响目前尚未见报道,本文就外源性生长抑素对脑出血患者血清炎性介质的影响进行研究,为脑出血的治疗及生长抑素的临床应用提供参考。
1资料与方法
1.1临床资料
选取2007~2009年河南省商丘市人民医院神经内科及特需病房住院治疗的脑出血患者60例,随机分为治疗组及干预组各30例,治疗组男18例,女12例,年龄39~78岁,平均(52.4±6.1)岁,其中基底节出血12例,丘脑出血10例,脑叶出血8例。干预组男21例,女9例,年龄41~79岁,平均(53.6±5.8)岁,其中丘脑出血15例,基底节出血6例,脑叶出血9例,对照组健康人群来自本院体检中心体检者,其中男20例,女10例,年龄40~76岁,平均(54.1±6.4)岁,三组间性别、年龄无显著差异、治疗组及干预组间病变部位及疾病严重程度无明显差异,具有可比性。本研究经本院伦理委员会批准,所有参与者知情同意。
1.2治疗方法
患者入院后,依据病情给予止血剂,脑保护剂、降压药物及脱水剂,抗酸、预防感染,摄入不足者给予营养支持,干预组在治疗组治疗措施基础上给予生长抑素(stilamin,瑞士雪兰诺公司生产,批号:0550504D01)2.5μg/h微量泵24h持续泵入,连续1周。
1.3标本采集及检测
对照组人群自体检中心清晨空腹采集静脉血,治疗组及干预组患者入院第1天采集清晨空腹静脉血,血液6mL,置于4℃预冷的试管内,加入10%EDTA-Na230μL/mL、抑肽酶500kIU/mL,混匀后低温离心,血清保存于深低温冰箱待测,其中2mL标本分别经冷丙酮、乙酸乙醋-乙醚去蛋白及应用生长抑素放射免疫分析盒(购自上海朗顿生物科技有限公司)采用SN -695型智能放射免疫γ测量仪(上海原子能研究所)检测样本生长抑素水平,应用TNF-α、IL-6及IL-10Elisa试剂盒(购自南京建成生物工程研究所)检测应用721型分光光度计(北京仪器厂)检测血清标本TNF-α、IL-6及IL-10浓度,所有操作均严格按照试剂及仪器使用说明书进行。
1.4统计学方法
数据处理采用SPSS13.0软件包处理,统计学方法三组间比较采用方差分析SLN-Q检验,两组间比较采用配对资料t检验,组间相关性检验采用Peason相关性检验,P
