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目的探讨神经生长因子(NGF)和双肾上腺皮质激素(DCX)与重型创伤性颅脑损伤患儿预后的相关性。方法 12例重型颅脑损伤患儿设为试验组,另纳入12例为排除脑膜炎进行腰椎穿刺的患儿设为对照组。脑损伤后2 h(T1)、48 h(T2)收集患儿脑脊液,采用双位酶免疫法测定NGF浓度,免疫印迹法分析DCX表达水平。治疗后6个月末使用格拉斯哥预后评分(GOS)对试验组患儿进行疗效评估,分析NGF、DCX与预后的关系。结果试验组T1时NGF水平明显高于对照组(P<0.01),T2时与T1时相比有显著增高(P<0.05)。T1时预后好与差的患儿NGF水平无显著差异(P>0.05),T2时预后好的患儿NGF水平高于预后差的患儿[(414.93±135.51)pg·mL~(-1)vs.(186.72±104.18)pg·mL~(-1),P<0.05]。对照组DCX表达始终保持在基础水平,试验组T1时预后好和预后差的患儿DCX水平无显著差异(P>0.05),T2时DCX水平分别为(2.25±0.41)ng·mL~(-1)和(0.11±0.04)ng·mL~(-1),有显著差异(P<0.05)。NGF和DCX之间有显著相关性,相关系数为0.76(P<0.05)。结论创伤性早期NGF和DCX上调的重度脑损伤患儿有较好的临床治疗效果,提示NGF和DCX有助于改善重型颅脑损伤的预后。
Objective To investigate the relationship between nerve growth factor (NGF) and adrenocorticotropic hormone (DCX) in children with severe traumatic brain injury. Methods Twelve children with severe craniocerebral injury were enrolled in the study group. Twelve children with lumbar puncture who were excluded for meningitis were enrolled as control group. The cerebrospinal fluid of children was collected at 2 h (T1) and 48 h (T2) after brain injury. The concentration of NGF was measured by double enzyme immunoassay and the expression of DCX was analyzed by immunoblotting. Six months after treatment, the Glasgow Outcome Scale (GOS) was used to evaluate the efficacy of the treatment group. The relationship between NGF, DCX and prognosis was analyzed. Results The level of NGF in test group was significantly higher than that in control group (P <0.01), while the level of NGF in T2 group was significantly higher than that in T1 group (P <0.05). The level of NGF in children with good prognosis was significantly higher than that in children with poor prognosis [(414.93 ± 135.51) pg · mL ~ (-1)] at T1 (P> 0.05) vs. (186.72 ± 104.18) pg · mL -1, P <0.05]. DCX expression in the control group remained at the basal level all the time, there was no significant difference in DCX level between the two groups (P> 0.05), and the level of DCX in T2 group was (2.25 ± 0.41) ng · mL ~ (- 1) and (0.11 ± 0.04) ng · mL -1, respectively (P <0.05). There was a significant correlation between NGF and DCX with a correlation coefficient of 0.76 (P <0.05). Conclusions The results suggest that NGF and DCX can improve the prognosis of severe traumatic brain injury in children with severe traumatic brain injury with early NGF and DCX trauma.