Study On The Dynamic Changs Of EPC, WBC And PLAT In The Peripheral Blood Of TBI Patients

Objectives:This study was designed to monitor Endothelial Progenitor Cells (EPCs), White Blood Cells (WBCs) and Platelets (PLATs) in the peripheral blood of patients suffered Traumatic Brain Injury (TBI), and to investigate those naturally dynamic changs associated with clinical significances to facilitate TBI treatments.Methods:86patients with TBI from Tianjin Medical University and Huanhu Hospital were observed sine2006, and77patients were included in this study expect9patients with over2000ml blood transfusion. All of the patients were diagnosed as TBI, supported by CT and MRI, and the age ranged from18to85(58male,19female).27patients were so treated conservatively and50patients aggressively that15patients died and62patients survived. The severity of TBI was graded from Glasgow Coma Scale (GCS)(13-15,32cases;9-12,18cases; and3-8,27cases). The first blood collection was performed within48hr after administration, and blood samples were also collected at day4, day7, day14and day21after TBI. EPCs were labeled by PE-CD133and FITC-CD34monoclonal antibodies, and analyzed by Flow Cytometer. WBCs and PLATs were assayed by Complete Blood Count. Using Enzyme Immunosorbent Assay Thrombospondin-1(TSP-1) and C-reactive protein (CRP) were evaluated as well. The outcome was designated as improvement (GCS increasing) and aggravation (GCS decreasing).Results:EPCs remained a low level at day1after TBI, peak at one week and gradually decreased to the control levels. The numbers of EPCs were significantly higher in the TBI group at one week compared with that of EPCs at day1and day4. EPCs in under-50-year group were elevated compared with those in above-50year group, and EPCs in improvement group and conscious group were higher than those in aggravation group and unconscious group. The number of WBCs hit the highest point at post-injury day1. The whole changing tendency and the number of WBCs at day7and14after injury in infection group were significantly higher than those in non-infection group. In addition, the number of WBCs in unconscious group and aggravation group were notably higher than that of WBCs in conscious group and improvement group. The number of PLATs decreased slightly1day after TBI, increased progressively to reach its zenith at day14, and then declined to its normal value. Both changing tendency of TSP1and CRP, as the response to TBI, were approximately the same:decreased slightly at day1after injury, rose gradually and climaxed at day14and21after injury. The number of TSP1and CRP correlated with each other at day4, day7, day14and day21.Conclusion:1. EPCs decline at the early phase of TBI, rises persistently to reach its climax, and then decreases determinedly to remain a higher level than those in health adult.2. The number of WBCs is significantly higher in patients with severe TBI than that of WBCs in patients with mild TBI, and the increase of WBC correlates with the extent of TBI3. The rise of WBC in the1st week can not be regard as the indicator for infection,the continous rise of WBC in the2nd week can regard as the indicator for infection. The patients with the rise of WBCs and decline of EPCs within1-2weeks have a good prognosis and vice versa.4. The changing tendency of WBCs and EPCs links with the prognosis of TBI patients. The patients with comparatively low level of EPCs within2-3weeks prognoses badly, and with high level of EPCs well.5. The increasing extents of PLATs are different between male and female TBI patients. One week after TBI the rising degree of PLATs in male patients are significantly higher than that of PLATs in female ones.6. The changing tendency of TSP1and CRP, monitored as inflammation reaction objects, are identical and positively correlate with each other.