Department of Rehabilitation Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Ann Palliat Med. 2021 Aug;10(8):9114-9121. doi: 10.21037/apm-21-1852.
Inflammatory processes are known to be the key secondary effects of severe traumatic brain injury (sTBI). The aim of the present study was to assess the value of peripheral inflammatory markers in the chronic unconscious phase after sTBI.
This was a prospective cohort study. A total of 101 patients with prolonged disorder of consciousness (DoC) and 22 healthy controls (HC) were enrolled in the study. Serum levels of interleukin (IL)-1β, -4, -6, -10, -13, and tumor necrosis factor-α (TNF-α) were investigated in patients with prolonged DoC after sTBI. In addition, the Coma Recovery Scale-revised (CRS-R) was used to quantify the consciousness level, and clinical outcomes at 12 months were determined using the Glasgow Outcome Scale (GOS). Predictive logistic model was built based on the demographic characteristics and cytokine levels.
At baseline, IL-6, -10, -13, and TNF-α levels were significantly higher in patients with prolonged DoC compared with controls, while no differences in cytokine levels were observed between patients in a vegetative state (VS) and those in a minimally conscious state (MCS). IL-13 and TNF-α were found to be correlated with behavioral scores in patients with prolonged DoC, and were associated with recovery 12 months later.
The results of the study provide information about long-term inflammatory responses in the chronic unconscious phase after brain trauma. Further larger studies are required to validate the value of these inflammatory markers.
已知炎症过程是严重创伤性脑损伤（sTBI）的关键继发效应。本研究旨在评估外周炎症标志物在 sTBI 后慢性无意识阶段的价值。
这是一项前瞻性队列研究。共纳入 101 例持续性意识障碍（DoC）患者和 22 例健康对照（HC）。在 sTBI 后持续性 DoC 的患者中检测血清白细胞介素（IL）-1β、-4、-6、-10、-13 和肿瘤坏死因子-α（TNF-α）水平。此外，采用昏迷恢复量表修订版（CRS-R）量化意识水平，采用格拉斯哥结局量表（GOS）确定 12 个月时的临床结局。基于人口统计学特征和细胞因子水平建立预测逻辑模型。
在基线时，持续性 DoC 患者的 IL-6、-10、-13 和 TNF-α水平明显高于对照组，而在植物状态（VS）和最小意识状态（MCS）患者之间，细胞因子水平无差异。IL-13 和 TNF-α与持续性 DoC 患者的行为评分相关，与 12 个月后的恢复相关。
该研究结果提供了脑外伤后慢性无意识阶段长期炎症反应的信息。需要进一步的大型研究来验证这些炎症标志物的价值。
