血清免疫球蛋白及补体C3、C4水平与高血压性脑出血患者预后的关系

doi:10.3969/j.issn.1004-583X.2021.02.002

摘要/Abstract

摘要：

目的探究高血压性脑出血(HICH)患者血清免疫球蛋白、补体C3、补体C4的变化及预后的关系。方法选取我院收治的150例HICH患者作为研究对象,根据发病1个月后改良Rankin量表评分(mRS)划分为预后良好组和预后不良组,另择同期体检正常的健康人作为对照组;收集格拉斯哥昏迷量表(GCS)评分、神经缺损程度的量表(NIHSS)评分及血肿量,采用免疫透射比浊法测定IgG、IgA、IgM及补体C3、C4。结果预后不良组第1 d GCS评分低于预后良好组(P<0.05),NIHSS评分、血肿量及WBC高于预后良好组(P<0.05)。预后不良组、预后良好组及对照组第1 d体液免疫IgG、IgM及补体C3、C4水平比较差异有统计学意义(P<0.05),预后不良组、预后良好组IgG、IgM及补体C3、C4水平均低于对照组(P<0.05),预后不良组IgG、IgA、IgM及补体C3、C4水平均低于预后良好组(P<0.05)。2组患者均第3 d血清IgG、IgM水平下降至最低;组间、同时点比较,预后不良组第1 d、3 d血清IgG、IgM、C3、C4均低于预后良好组(P<0.05),预后不良组第11 d血清补体C3、C4均高于预后良好组(P<0.05)。2组IgG、C3、C4的组间、不同时点及组间和不同时点的交互作用均有统计学意义(P<0.05),不同时间、组别的IgM比较差异有统计学意义(P<0.05)。IgG、IgM、C3、C4水平与GCS评分均呈正相关(P<0.05);IgG、IgM、C3、C4水平与NIHSS评分、血肿量及WBC呈负相关(P<0.05)。结论 HICH患者体内存在体液免疫抑制,血清免疫球蛋白及补体C3、C4水平均低于正常人水平,且HICH不良预后患者体液免疫抑制或激活程度高于预后良好患者。

关键词: 颅内出血, 高血压性, 免疫, 体液, 免疫球蛋白类, 补体C3, 补体C4

Abstract:

Objective To explore the relations between serum immunoglobulin, changes in complement C3 and complement C4 and prognosis of hypertensive intracerebral hemorrhage(HICH) patients. Methods One hundred and fifty HICH patients admitted by the hospital were selected as study subjects, and the patients were divided into good prognosis group and poor prognosis group according to Modified Rankin Scale(mRS) scores of patients in one month after the onset of diseases, and healthy people with normal physical results during the same period were selected into normal control group. Glasgow Coma Scale (GCS) scores, NIH Stroke Scale (NIHSS) scores and hematoma volume were collected. IgG, IgA, IgM and C3 and C4 of serum samples were determined by immunoturbidimetry. Results GCS scores of poor prognosis group on the the 1st day were significantly lower than those of good prognosis group (P<0.05), and NIHSS score, hematoma volume and WBC of poor prognosis group were significantly higher than those of good prognosis group (P<0.05).The comparative difference in the level of IgG, IgM, complement C3 or complement C4 of humoral immunity of patients in poor prognosis group, good prognosis group and control group on the 1st day was statistically significant (P<0.05), and the level of IgG, IgM, complement C3 or complement C4 of poor prognosis group and good prognosis group was significantly lower than those of the control group (P<0.05), the level of IgG, IgA, IgM or complement C3 or complement C4 of poor prognosis group was significantly lower than those of good prognosis group (P<0.05). The serum level of IgG or IgM of both groups was minimized on the 3rd day. IgG, IgM, complement C3 or complement C4 of poor prognosis group for inter-group and identical time-point comparison on the 1st 3rd days were lower than those of good prognosis group (P<0.05), and the level of complement C3 or complement C4 of poor prognosis group on the 11th day were higher than those of good prognosis group (P<0.05). The inter-group interactions of IgG, complement C3 and complement C4 of patients at identical or different time points were statistically significant (P<0.05), and the comparison in IgM of patients in groups at different time points was statistically significant (P<0.05). The level of IgG, IgM, complement C3 or complement C4 were positively correlated with GCS scores (P<0.05). The level of IgG, IgM, C3 or C4 was negatively correlated with NIHSS scores, hematoma volume and WBC (P<0.05). Conclusion HICH patients are found to have suppressed humoral immune, serum immunoglobulin and level of complement C3 or complement C4 below than that of normal patients, and HICH patients with poor prognosis show suppressed humoral immunity or activation level higher than that of patients with good prognosis.

Key words: intracranial hemorrhage, hypertensive, immunity, humoral, immunoglobulins, complement C3, complement C4

中图分类号:

R743.34

吴亮, 刘明. 血清免疫球蛋白及补体C3、C4水平与高血压性脑出血患者预后的关系[J]. 临床荟萃, 2021, 36(2): 107-111.

Wu Liang, Liu Ming. Relations between serum immunoglobulin, level of complement C3 or complement C4 and prognosis of hypertensive intracerebral hemorrhage patients[J]. Clinical Focus, 2021, 36(2): 107-111.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.02.002

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I2/107

图/表 4

参考文献 15

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组别	例数	收缩压(mmHg)	舒张压(mmHg)	GCS(分)	NIHSS(分)	血肿量(ml)	WBC(×10⁹/L)
预后不良组	53	182.61±18.75	105.86±13.41	10.71±3.59	17.55±4.28	32.13±7.88	18.23±4.02
预后良好组	97	176.86±17.84	101.86±12.9	13.97±3.93	8.63±2.25	19.86±6.39	12.83±3.24
t值		1.853	1.790	5.115	16.740	9.191	8.947
P值		0.066	0.075	0.000	0.000	0.000	0.000

组别	例数	收缩压(mmHg)	舒张压(mmHg)	GCS(分)	NIHSS(分)	血肿量(ml)	WBC(×10⁹/L)
预后不良组	53	182.61±18.75	105.86±13.41	10.71±3.59	17.55±4.28	32.13±7.88	18.23±4.02
预后良好组	97	176.86±17.84	101.86±12.9	13.97±3.93	8.63±2.25	19.86±6.39	12.83±3.24
t值		1.853	1.790	5.115	16.740	9.191	8.947
P值		0.066	0.075	0.000	0.000	0.000	0.000

组别	例数	IgG	IgA	IgM	C3	C4
预后不良组	53	11.14±3.02^*△	2.47±0.72	1.06±0.33^*△	0.87±0.23^*△	0.24±0.08^*△
预后良好组	97	12.12±3.48	2.40±0.83	1.20±0.37^*	0.98±0.30^*△	0.27±0.07^*△
对照组	30	13.76±3.01	2.49±0.65	1.36±0.43	1.32±0.40	0.31±0.05
F值		6.128	0.231	6.486	22.131	9.631
P值		0.003	0.794	0.002	0.000	0.000

组别	例数	IgG	IgA	IgM	C3	C4
预后不良组	53	11.14±3.02^*△	2.47±0.72	1.06±0.33^*△	0.87±0.23^*△	0.24±0.08^*△
预后良好组	97	12.12±3.48	2.40±0.83	1.20±0.37^*	0.98±0.30^*△	0.27±0.07^*△
对照组	30	13.76±3.01	2.49±0.65	1.36±0.43	1.32±0.40	0.31±0.05
F值		6.128	0.231	6.486	22.131	9.631
P值		0.003	0.794	0.002	0.000	0.000

组别	例数		IgG			IgA
组别	例数		第1 d	第3 d	第11 d	第1 d	第3 d	第11 d
预后不良组	53		11.14±3.02^△	9.23±2.18^△*	13.83±4.00^*#	2.47±0.72	2.13±0.63	2.57±0.73
预后良好组	97		12.12±3.48	11.58±3.00^*	13.23±4.61^#	2.40±0.83	2.27±0.70	2.40±0.97
组间			F=24.283 P<0.05			F=0.545 P>0.05
时点间			F=4.209 P<0.05			F=0.317 P>0.05
组间·时点间			F=3.604 P<0.05			F=0.545 P>0.05
组别	例数		IgM			C3
组别	例数		第1 d	第3 d	第11 d	第1 d	第3 d	第11 d
预后不良组	53		1.06±0.33^△	0.63±0.22^△*	1.03±0.27^△	0.87±0.23^△	1.93±0.60^△*	1.93±0.53^△*
预后良好组	97		1.20±0.37	0.79±0.30^*	1.15±0.31^#	0.98±0.30	1.23±0.32^*	1.24±0.35^*
组间			F=676.909 P<0.05			F=377.926 P<0.05
时点间			F=64.146 P<0.05			F=68.333 P<0.05
组间·时点间			F=159.695 P<0.05			F=138.816 P<0.05
组别		例数	C4
组别		例数	第1 d		第3 d		第11 d
预后不良组		53	0.24±0.08^△		0.51±0.13^△*		0.43±0.11^△*
预后良好组		97	0.27±0.07		0.38±0.11^*		0.33±0.10
组间			F=199.264 P<0.05
时点间			F=88.583 P<0.05
组间·时点间			F=53.881 P<0.05