Clinical study on the changes of peripheral inflammatory markers and oxidative stress during post-acute and chronic phase after severe traumatic brain injury

Abstract

Objective To explore the clinical changes of peripheral inflammatory markers and oxidative stress during post?acute and chronic phase after severe traumatic brain injury (sTBI).  Methods A total of 24 sTBI patients were included in this study. The changes of peripheral inflammatory markers [interleukin (IL)-1β, IL-6, interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α)] and oxidative stress parameters [glutathione peroxidase (GSH - Px), superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR) and total plasma antioxidant activity (TEAA)] were monitored. Functional Independence Measure (FIM) and Dyskinesia Rating Scale (DRS) were used to evaluate cognitive function and motor function.  Results There were significant differences on IL-6 (F = 105.982, P = 0.000), IFN-γ (F = 19.873, P = 0.000), GSH-Px (F = 162.090, P = 0.000), SOD (F = 28.254, P = 0.000) and CAT (F = 4.782, P = 0.011) during different periods of sTBI (post-acute phase, chronic early phase, chronic phase). IL-6 and GSH-Px in chronic early phase (IL-6: t = 11.753, P = 0.000; GSH-Px: t = 16.901, P = 0.000) and chronic phase (IL-6: t = 14.533, P = 0.000; GSH-Px: t = 13.828, P = 0.000) were significantly lower than post-acute phase. IL-6 and GSH-Px in chronic phase (IL-6: t = 2.341, P = 0.012; GSH-Px: t = 3.073, P = 0.003) were significantly lower than chronic early phase. SOD in chronic early phase and chronic phase was significantly higher than post-acute phase (t = 7.264, P = 0.000; t = 5.303, P = 0.000). CAT in chronic early phase was significantly higher than post-acute phase (t = 3.060, P = 0.003). After 12 months, 24 patients completed the follow-up, and their FIM scores were significantly increased (t = 36.260, P = 0.000), while DRS scores were significantly decreased (t = 49.010, P = 0.000). Pearson correlation analysis showed that IL-6 (r = 0.446, P = 0.020) and GSH-Px (r = 0.142, P = 0.000) were positively correlated with overall cognitive performance index (CPI). IL-6 was positively correlated with attention (r = 0.431, P = 0.026) and executive function (r = 0.522, P = 0.005) of synthetic index (SI). IFN-γ (r = 0.497, P = 0.009) and TNF-α (r = 0.479, P = 0.009) were positively correlated with executive function of SI. GSH-Px was positively correlated with all SI (r = 0.220, P = 0.000; r = 0.344, P = 0.000; r = 0.011, P = 0.000).  Conclusions Imbalance of oxidative stress response and over-production of inflammatory markers in acute phase of patients with severe traumatic brain injury might adversely affect the neurological functional recovery. Inflammatory markers and oxidative stress response might offer a feasible way to monitor recovery and predict the prognosis after severe traumatic brain injury.

DOI: 10.3969/j.issn.1672-6731.2018.02.009