CAJ | 학술논문

目的观察亚低温对脑肿瘤患者血液和脑脊液热休克蛋白70(HSP70)、IL-6和TNF-α的影响,探讨低温对脑保护的分子机理.方法选择40例脑肿瘤切除患者,按照随机数字表法分为低温组[手术中应用充气温控毯降温,维持鼻咽温度在(34.8±0.6)℃直至肿瘤切除完毕,随后进行复温]和常温组[手术中应用充气温控毯维持术中鼻咽温度在(36.6±0.4)℃],每组20例.2组患者在麻醉诱导前(TI1、打开硬脑膜后1 h(T2)以及术后24 h(T3)采集颈内静脉血和脑脊液,应用ELISA法检测HSP70、IL-6、TNF-α含量,并对结果进行统计学分析.结果与常温组相比,低温组中心温度从手术开始至肿瘤切除完毕均明显降低,差异有统计学意义(P<0.05).2组血液、脑脊液HSP70随时间推移均呈上升趋势,但低温组HSP70在T2和T3时间点明显高于相应时间点的常温组,差异均有统计学意义(P<0.05).低温组血液、脑脊液中IL-6和TNF-α在T2和T3时间点明显低于相应时间点的常温组,差异均有统计学意义(P<0.05).常温组在T1、T2时间点,与血液中HSP70相比,脑脊液中HSP70含量明显较高,差异有统计学意义(P<0.05).结论亚低温可增高脑肿瘤患者血液和脑脊液中HSP70的表达,降低Ⅱ-6和TNF-α的表达.脑脊液HSP70可更敏感反映脑组织损伤.
목적 관찰아저온대뇌종류환자혈액화뇌척액열휴극단백70(HSP70)、IL-6화TNF-α적영향,탐토저온대뇌보호적분자궤리.방법 선택40례뇌종류절제환자,안조수궤수자표법분위저온조[수술중응용충기온공담강온,유지비인온도재(34.8±0.6)℃직지종류절제완필,수후진행복온]화상온조[수술중응용충기온공담유지술중비인온도재(36.6±0.4)℃],매조20례.2조환자재마취유도전(TI1、타개경뇌막후1 h(T2)이급술후24 h(T3)채집경내정맥혈화뇌척액,응용ELISA법검측HSP70、IL-6、TNF-α함량,병대결과진행통계학분석.결과 여상온조상비,저온조중심온도종수술개시지종류절제완필균명현강저,차이유통계학의의(P<0.05).2조혈액、뇌척액HSP70수시간추이균정상승추세,단저온조HSP70재T2화T3시간점명현고우상응시간점적상온조,차이균유통계학의의(P<0.05).저온조혈액、뇌척액중IL-6화TNF-α재T2화T3시간점명현저우상응시간점적상온조,차이균유통계학의의(P<0.05).상온조재T1、T2시간점,여혈액중HSP70상비,뇌척액중HSP70함량명현교고,차이유통계학의의(P<0.05).결론 아저온가증고뇌종류환자혈액화뇌척액중HSP70적표체,강저Ⅱ-6화TNF-α적표체.뇌척액HSP70가경민감반영뇌조직손상.
Objective To observe the effects of mild hypothermia on the heat shock protein 70 (HSP70), interlukin 6 (IL-6) and tumor necrosis factor-α (TNF-α) in blood and cerebrospinal fluid in patients with cerebroma and explore the molecular mechanism of hypothermia on cerebral ischemia. Methods Forty patients, selected for cerebroma resection under microscopy, were randomized innormothermia group (n=20, 36.6±0.4 ℃) and hypothermia group (n=20,34.8±0.6 ℃). These temperatures were guaranteed by air temperature control blanket. Jugular venous blood and cerebrospinal fluid were collected before the anesthesia induction (T1), 1 h after opening the endocranium (T2) and 24 h after the operation (T3). The content of HSP70, IL-6 and TNF-α in the blood and cerebrospinal fluid was measured by ELISA, and the results were statically analyzed. Results The core temperature in the hypothermia group was decreased significantly from starting the operation to the end of tumor resection as compared with that in the normothermia group (P<0.05). The level of HSP70 in blood or cerebrolspinal fluid presented an increasing trend in both groups, and the level of HSP70 at T2 and T3 in the hypothermia group was significantly higher than that in the normothermia group (P<0.05). Compared with those in the normothermia group, the levels of IL-6 and TNF-α in blood or cerebrospinal fluid at T2 and T3 in the hypothermia group were significantly lower (P<0.05). At T1 and T2 in the normothermia group, the content of HSP70 in cerebrospinal fluid was obviously higher than that in blood (P<0.05).Conclusion Mild hypothermia can increase the expression level of HSP70 in blood and cerebrospinal fluid and decrease the level of IL-6 and TNF-α in blood and cerebrospinal fluid. HSP70 in cerebrospinal fluid might be more sensitive than that in blood in presenting the brain injury.