The Study Of Serum Protein Changes And Its Mechanism In Patients With Acute Craniocerebral Trauma

Objectives:To detect the level of serum total protein, albumin, interleukin-6(IL-6), tumor necrosis factor-a (TNF-a) and endotoxin, to explore serum protein changes and its mechanism in acute craniocerebral trauma, in order to provide conference for clinical nutrition support and reducing secondary brain trauma.Object and method:65patients with craniocerebral trauma from January,2008to September,2011in our hospital were included in the study. Inclusion criteria:1. admission in three days after injury.2. No massive hemorrhage and shock after injury.3. No combined injuries.4. No history of cerebrovascular disease, epilepsy and diabetes, no history of heart, liver and kidney diseases.5. No intracranial and other organs infection.6. Age between18to65years old.7. With the exception of malnutrition.8. Not using immunosuppressant. All the patients had not persistence hyperthermy and multiple organ dysfunction syndrome, lived for more than15days after injury. The patients were divided into three groups according to Glasgow Coma Scale when admission. Those who scored between3to8belonged to severe craniocerebral trauma; Those who scored between9to12belonged to moderate craniocerebral trauma; Those who scored no more than13belonged to mild craniocerebral trauma.20normal physical examinees were control group. Method:The patients were given suitable nutrition treatment according to patients’condition. Patients were drawn fasting blood samples from vein three times on2,8,15days,after admission. The control groups were drawn fasting blood samples from vein. Then plasma separation by centrifugation was done immediately, and serum total protein, albumin and prealbumin were measured. IL-6, TNF-a and endotoxin were measured by ELISA. All data were analyzed by SPSS16.0. The statistical description included mean±standard deviation. The statistical analysis included ANOVA, LSD test and Pearson’s correlation. p<0.05means significance of differences.Results:The level of serum total protein, albumin in patients with craniocerebral trauma were lowest on8days after admission, would increase on15days, but still lower than normal. The level of serum total protein in patients with severe craniocerebral trauma was significantly lower than those in patients with mild craniocerebral trauma and control group(p<0.05). The level of albumin in patients with severe craniocerebral trauma was 28.93±5.19g/L,which was significantly lower than that of other groups(p<0.05). The level of albumin in patients of moderate group significantly was lower than mild group at8days. The prealbumin level of patients with severe craniocerebral trauma significantly was lower than moderate and mild group at2days. And to compare with tne moderate was not statistically significant difference. The prealbumin level of patients with severe craniocerebral trauma significantly was lower than moderate and mild group at8days. Although the prealbumin level of patients with severe craniocerebral trauma was lower than other groups at15days,but was not statistically significant difference (p>0.05)The level of IL-6, TNF-a and endotoxin in different groups of patients were all significantly higher than those in control group. The level of TNF-a and endotoxin were highest on2days after admission. The levels of IL-6were highest on8days after admission. The highest level of IL-6, TNF-a and endotoxin in patients with severe craniocerebral trauma were0.34±0.03μg/L、2.28±0.14μg/L、49.83±5.16ng/L, expectively, which were significantly higher than those in control group and patients with moderate and mild craniocerebral trauma(p<0.05). The level of IL-6, TNF-a and endotoxin in patients with moderate craniocerebral trauma were significantly higher than those in control group and patients with mild craniocerebral trauma(p<0.05). There were no significant difference among other groups (p>0.05)The correlation showed that the level of IL-6, TNF-a and endotoxin were significantly negative correlated with the level of serum total protein,albumin(p<0.05).Conclusions:The level of serum protein decreases after acute craniocerebral trauma. It has a close relationship with the degree of injury.The level of IL-6, TNF-a and endotoxin incerease markedly after acute craniocerebral trauma. The severer craniocerebral trauma, the greater the increase range.In a certain dgree ther easonable nutrition intervention can hamper the decreasel of serum,but we still need to retrieve acromegalic phlegmonosis state andstress reaction for retrieving malnutrition.