Abstract
Objective. The aim of the work was to compare the content of α-defensins (HNP 1-3), pro- and anti-inflammatory cytokines in plasma and cerebrospinal fluid (CSF) and their role in the development of a systemic inflammatory response in the post-traumatic period in patients with severe traumatic brain injury (TBI). Materials and methods. Under the supervision there were 20 patients with severe traumatic brain injury aged 18 to 78 years (mean age 38.3 ± 11.5 years). In the first 24 hours and 7 days after the injury, the patients underwent lumbar puncture with cerebrospinal fluid and peripheral blood sampling from the central vein. The quantitative contents of α-defensins in plasma and cerebrospinal fluid, cytokines in serum and CSF were determined by ELISA with a kit for determining human α-defensins and cytokines. Results. The results of the studies showed that severe head injury is accompanied by increased production of antimicrobial peptides (α-defensins - HNP 1-3), pro- and anti-inflammatory cytokines, whose products have a number of features in the dynamics of the inflammatory process in the brain. On the first day after TBI in plasma and CSF, there is a significant increase in the concentration of HNP 1-3. The level in the blood plasma significantly exceeds their content in CSF by 9.7 times. In the dynamics on the seventh day after injury there was a decrease in the content of HNP 1-3 in the blood plasma and CSF, more pronounced in the cerebrospinal fluid. Between the level of HNP 1-3 and IL-1β in plasma, HNP 1-3 and protein content, cytosis in the cerebrospinal fluid on the 1st day, and also between HNP 1-3 and the anti-inflammatory cytokine IL-10, both in blood plasma and in the cerebrospinal fluid on the 7th day a direct correlation dependence was revealed, reflecting the dynamics of the inflammatory process in the brain. Conclusion: The level of HNP 1-3 in plasma and CSF can serve as a prognostic criterion for the severity, course, and outcome of TBI.
Highlights
The aim of the work was to compare the content of α-defensins (HNP 1-3), pro- and anti-inflammatory cytokines in plasma and cerebrospinal fluid (CSF) and their role in the development of a systemic inflammatory response in the post-traumatic period in patients with severe traumatic brain injury (TBI)
The results of the studies showed that severe head injury is accompanied by increased production of antimicrobial peptides (α-defensins – HNP 1-3), pro- and anti-inflammatory cytokines, whose products have a number of features in the dynamics of the inflammatory process in the brain
On the first day after TBI in plasma and CSF, there is a significant increase in the concentration of HNP 1-3
Summary
Данное исследование было утверждено Комитетом по этике и проведению клинических исследований КГМУ (протокол No 9 от 09.11.15 г.). Под наблюдением было 20 пациентов с тяжелой черепно-мозговой травмой в возрасте от 18 до 78 лет (средний возраст 38,3±11,5 лет), находившихся в нейрохирургическом отделении Курской областной клинической больницы, среди которых преобладали лица мужского пола (15 пациентов). Критериями включения пациентов в исследование являлись: тяжелая ЧМТ, средний уровень сознания по шкале комы Глазго – 6,8±1,2 балла. Средний балл по шкале исходов Глазго – 3,9±0,5 балла. Диагностика и лечение ЧМТ проводились в соответствии с требованиями Стандарта специализированной помощи при внутричерепной травме [2, 5]. Количественное содержание α-дефензинов (HNP 1-3) в плазме крови и цереброспинальной жидкости (ЦСЖ), цитокинов (ИЛ-1β, ФНО-α, ИЛ6, ИЛ-8, ИФН-γ, ИЛ-10) в сыворотке крови и ЦСЖ определяли методом ИФА с набором для определения человеческих α-дефензинов (ELISAkit, HyCult biotechnology, Нидерланды) и цитокинов («Вектор-Бест, Россия»). Принимаемых за физиологическую норму, обследовано 20 здоровых лиц (средний возраст 38,3±11,5 лет). Для выявления корреляционной связи между показателями использовали коэффициент ранговой корреляции Спирмена
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