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目的研究弥漫性轴索损伤(DAI)后患者外周血CD4+/CD8+T细胞比值及炎症因子IL-6、IL-10水平的变化,探讨影响DAI患者预后的相关危险因素及可能的预测因子。方法收集115例DAI患者的相关临床资料及伤后至少6个月的随访结果,并将采集的患者外周血采用流式细胞仪检测CD4+、CD8+T细胞及其比值,ELISA法检测IL-6、IL-10水平,对免疫炎症指标及临床资料进行单因素和多因素分析,多因素分析采用Logistic回归分析。结果DAI后合并其他脑损伤、瞳孔改变、伤后昏迷时间及入院时GCS评分是影响患者预后的危险因素,而其他因素则与预后不相关。CD4+/CD8+T淋巴细胞比值降低是DAI后发生ARDS/ALI的危险因素,CD4+/CD8+T淋巴细胞比值与患者预后关系不大,而ARDS/ALI的发生则是影响DAI患者预后的重要危险因素。IL-6增加与DAI后ARDS/ALI密切相关,可作为ARDS/ALI发生的预测因子,其水平是患者预后的危险因素,而IL-10则在此过程中与ARDS/ALI不相关,且与患者预后无关。结论 CD4+/CD8+T淋巴细胞比值降低是DAI后发生ARDS/ALI的危险因素,IL-6可作为ARDS/ALI发生的预测因子。DAI后与患者预后相关的危险因素包括合并其他脑损伤、瞳孔改变、伤后昏迷时间、入院时GCS评分、IL-6水平及并发ARDS/ALI。
Objective To study the changes of CD4 + / CD8 + T cells and inflammatory cytokines IL-6 and IL-10 in peripheral blood of patients with diffuse axonal injury (DAI) and to explore the related risk factors and possible predictors of prognosis in patients with DAI. Methods The clinical data of 115 patients with DAI and the follow-up results of at least 6 months after injury were collected. The peripheral blood of the collected patients were detected by flow cytometry and the ratio of CD4 +, CD8 + T cells and IL-6 , IL-10 levels, univariate and multivariate analysis of immune inflammation indicators and clinical data, multivariate analysis using Logistic regression analysis. Results DAI combined with other brain injury, pupil change, coma after injury time and admission GCS score risk factors affecting the prognosis of patients, while other factors are not related to the prognosis. The decrease of CD4 + / CD8 + T lymphocyte ratio is the risk factor of ARDS / ALI after DAI. The ratio of CD4 + / CD8 + T lymphocytes is not related to the prognosis of patients, while the incidence of ARDS / ALI is an important risk affecting the prognosis of patients with DAI factor. The increase of IL-6 is closely related to ARDS / ALI after DAI, which may be used as a predictor of ARDS / ALI. The level of IL-6 is a risk factor for the prognosis of patients. IL-10 is not related to ARDS / ALI in this process, The prognosis of patients has nothing to do. Conclusions The decrease of CD4 + / CD8 + T lymphocyte ratio is a risk factor of ARDS / ALI after DAI. IL-6 may be a predictor of ARDS / ALI. Risk factors associated with patient outcomes after DAI included other brain injury complications, pupil changes, post-traumatic coma, GCS admission admission, IL-6 levels, and concurrent ARDS / ALI.