目的 探讨注射用鼠神经生长因子(NGF)对重型颅脑损伤合并肺部感染患者血清高迁移率族蛋白-1(HMGB-1)和内源性分泌型晚期糖基化终产物受体(esRAGE)水平的影响,以及治疗前后血清促炎细胞因子白细胞介素1β(IL-1β),肿瘤坏死因子-α(TNF-α)的变化及相互关系.方法 选取达州市中西医结合医院2013年1月至2015年6月住院神经外科及ICU重型颅脑损伤合并肺部感染患者78例,随机数字法分组,对照组39例采取常规对症治疗,研究组39例均在常规治疗基础上采用注射用鼠NGF治疗.酶联免疫法(ELISA)测定血清HMGB1、esRAGE、IL-1β及TNF-α水平并在入院时、入院1w、2w时记录格拉斯哥昏迷评分(GCS)状况.结果 治疗2w后,研究组确诊1w、确诊2w时HMGB1和esRAGE水平低于对照组,差异有统计学意义(P<0.05);相比对照组,研究组确诊2w GCS评分明显低于低于对照组(P<0.01);研究组患者治疗前血清HMGB-1及esRAGE水平分别与IL-1β,TNF-α水平,GCS评分呈正相关(r1=0.238、r1=0.473、r2=0.429、r2=0.518,r3=0.319、r3=0.421,均P<0.05).结论 注射用鼠NGF能降低重型颅脑损伤合并肺部感染患者血清HMGB1及esRAGE水平,有明显治疗效果.且HMGB1及esRAGE可能在重型颅脑损伤合并肺部感染进程中发挥促炎作用,与IL-1β及TNF-α共同介导该类疾病的发生发展.%Objective To investigate the mouse nerve growth factor(NGF) for injection high mobility group protein-1(HMGB-1) in serum of patients with pulmonary infection in severe craniocerebral injury of endogenous secretory receptor for advanced glycation end products (esRAGE) levels, and serum proinflammatory cytokine interleukin 1 beta (IL-1 beta), tumor necrosis factor alpha (TNF- alpha) and the changes of the relationship. Methods Chinese and Western Medicine Hospital of Dazhou from January 2013 to June 2015 in the department of neurosurgery, and ICU diagnosed seventy-eight cases with severe craniocerebral injury complicated with pulmonary infection were randomly grouped, thirty-nine cases in the control group took routine symptomatic treatment, the study group of thirty-nine cases diagnosed by mouse nerve growth factor(NGF)for injection after treatment on the basis of routine treatment for 2 weeks. Enzyme linked immunosorbent assay (ELISA) was determined in the serum HMGB-1, esRAGE, IL-1 and TNF- levels and GlasgowComa Score(GCS) were recorded at 1 weeks and 2 weeks after diagnosis. Results after 2 weeks of treatment, the study group were diagnosed in 1 weeks and 2 weeks, the serum HMGB-1 of endogenous secretory receptor for advanced glycation end products (esRAGE) level is lower than the control group, the difference was statistically significant (P<0.05); compared with the control group, the study group diagnosed two weeks GCS the score was significantly lower than than in the control group (P<0.01); the study group of patients before treatment the serum HMGB-1 and esRAGE levels respectively and proinflammatory cytokine interleukin 1 beta (IL-1 beta), TNF-alpha levels, GCS were positively related (r1= 0.238,r1= 0.473,r2= 0.429,r2=0.518.r3= 0.319, r3=0.421,P<0.05).Conclusion Mouse NGF for injection can reduce the damage of serum HMGB-1 and esRAGE levels in patients with pulmonary infection in severe craniocerebral, has obvious curative effect.And HMGB-1 and esRAGE in severe craniocerebral injury complicated with pulmonary infection in the process of playing the proinflammatory effects, development of IL-1 and TNF- alpha beta mediated by the disease.
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