摘要目的 探讨创伤性脑损伤(traumatic brain injury,TBI)后缺氧诱导因子-1α(hypoxia-inducible factor-1α,HIF-1α)的表达及其临床意义.方法 病例组(标本为TBI患者外周血和开颅减压手术清除的脑组织)和对照组(标本为同期健康体检者外周血及手术摘除的脑血管瘤边缘少量正常脑组织)均60例.病例组再根据术前格拉斯哥昏迷评分(GCS)分为中度损伤组(9～12分,n=20),重度损伤组(3～8分,n=20)和特重度损伤组(<3分,n=20);根据发病至手术时间不同分为<6 h组(n=20)、≥6 h且≤24 h组(n=15)、>24 h且≤72 h组(n=14)、>72 h组(n=11).利用逆转录-聚合酶链反应(RT-PCR)和Western blot检测两组人群HIF-1αmRNA及蛋白的表达水平.采用SPSS 18.0进行单因素方差分析和t检验.结果 病例组HIF-1αmRNA及蛋白表达水平明显高于对照组[外周血HIF-1αmRNA(0.35±0.12),HIF-1α 蛋白(0.28±0.06);脑组织标本HIF-1αmRNA(0.65±0.08),HIF-1α 蛋白(0.78±0.08)],差异有统计学意义(P<0.05);随着损伤程度加重,HIF-1α 表达增强,特重度损伤组HIF-1α 表达最强,明显高于重度损伤组和中度损伤组,差异有统计学意义(P<0.05);随着伤后时间的延长,HIF-1α 表达量逐渐增多,>24 h且≤72 h组HIF-1α 表达最强,明显高于>72 h组、≥6 h且≤24 h组和<6 h组,差异有统计学意义(P<0.05).结论 TBI后HIF-1α 的表达显著升高,表达强度与脑损伤程度密切相关,在TBI发病中可能具有重要的作用.

abstractsObjective To investigate the expression of hypoxia-inducible factor-1α (HIF-1α) in patients with traumatic brain injury (TBI) and their clinical significance. Methods Peripheral blood and brain tissue samples were obtained from 60 TBI patients. According to the GCS score, 60 TBI patients were divided into the moderate damage group, the severe damage group and the especially severe damage group. According to the different time points after the injury, the patients were divided into <6 hours group, 6-24 hours group, 24-72 hours group and >72 hours group. The 60 control brain tissue samples were obtained from patients with cerebral aneurysms and undergoing craniotomy at the same time; and control peripheral blood were collected from 60 healthy people. The levels of HIF-1α were measured with RT-PCR and Western blot . One-way ANOVA and t-test were used to analyze the results with SPSS 18.0. Results The expression of HIF-1α in the control group [peripheral blood: HIF-1α mRNA (0.35±0.12), HIF-1α protein (0.28±0.06) ;brain tissue: HIF-1α mRNA (0.65±0.08),HIF-1α protein (0.78±0.08)] was obviously lower than those in the TBI groups, and the differences were statistically significant (P<0.05). Along with the damage degree aggravating, the expression of HIF-1α was increased. The expression of HIF-1α in the especially severe damage group was statistically higher than those of the severe damage group and the moderate damage group (P<0.05). The expression of HIF-1α was increased along with the extension of time after the injury. The expression of HIF-1α in the 24-72 h group was significantly higher than those of the >72 h group, 6-24 h group and <6 h group (P<0.05). Conclusions The expression of HIF-1α is closely related to the severity of TBI and may play an important role in the progress of TBI.