内科

目的探讨高血压脑出血（HICH）患者发病后外周血免疫球蛋白（IgG、IgM）和补体（C3、C4）水平变化趋势，为免疫支持治疗及判断患者预后提供参考。方法选取2015年1月至2016年1月我院神经外科收治的HICH患者90例为研究对象，按入院时Glasgow昏迷评分分为轻度HICH组（12～15分，30例）、中度HICH组（9～11分，30例）和重度HICH组（3～8分，30例）。选取同期我院收治的未发生脑出血的高血压患者30例作为高血压对照组，选取同期在我院进行健康体检的志愿者30名作为健康对照组。检测比较HICH患者（发病后1～28天）、高血压对照组患者及健康对照组志愿者外周血IgG、IgM、C3、C4水平。结果HICH患者入院后第1天的外周血IgG、IgM、C3、C4水平显著低于高血压对照组患者和健康对照组志愿者，差异有统计学意义（P＜0.05）。轻、中、重度HICH三组患者的外周血IgG、IgM、C3、C4水平比较差异有统计学意义（P＜0.05），三组患者的外周血IgG、IgM、C3、C4水平均随时间的变化而发生变化（P＜0.05）；三组患者的外周血IgG、IgM、C3、C4水平在入院后均逐渐降低，轻度、中度HICH患者在入院后第7天达最低水平，重度HICH患者在入院后第7天或10天达最低水平，随后均逐渐升高，入院后第28天的水平与第1天时的水平相当。结论HICH发生后患者免疫功能被抑制，发病后第7～10天被抑制的程度最为严重，在此期间宜对患者采取针对性措施，提高其免疫功能，减少感染的发生，改善患者预后。

ObjectiveTo explore the variation trend of levels in peripheral blood immunoglobulin (IgG, IgM), and complement (C3, C4) after the onset of patients with hypertensive intracerebral hemorrhage (HICH), to provide a reference for immune support therapy and prognosis judgment of patients. MethodsNinety patients with HICH admitted to the Department of Neurosurgery from January 2015 to January 2016 were selected as the research objects, and they were divided into mild HICH group (12-15 points, 30 cases), moderate HICH group (9-11 points, 30 cases) and severe HICH group (3-8 points, 30 cases) according to the Glasgow coma scores. During the same period, 30 hypertensive patients without occurring cerebral hemorrhage admitted to our hospital were selected as hypertension control group, and 30 volunteers undergoing physical examination in our hospital were selected as health control group. The peripheral blood levels of IgG, IgM, C3 and C4 in HICH patients (from 1 to 28 days after onset), the hypertension control group and the health control group were compared. ResultsThe peripheral blood levels of IgG, IgM, C3 and C4 were significantly lower in patients on the first day after admission than in the hypertension group and health control group, with statistically significant differences (P＜0.05). There were statistically significant differences in peripheral blood levels of IgG, IgM, C3 and C4 in the mild, moderate, and severe HICH groups (P＜0.05). The peripheral blood levels of IgG, IgM, C3 and C4 in the three groups mentioned above changed over time (P＜0.05), and the levels mentioned above gradually decreased in the three groups after admission; among which patients in the mild, moderate groups reached the lowest levels 7 days after admission, whereas HICH patients in the severe group attained the lowest levels 7 or 10 days after admission, and then the levels increased gradually, and the levels on the 28th day after admission were comparable to those on the first day after admission. ConclusionAfter the occurrence of HICH, the immune function of patients is suppressed, and the degree of suppression is the most serious from the 7th to the 10th day after onset. During this period, targeted measures should be employed to patients, to improve their immune function, reduce the occurrence of infection, and to improve prognosis in patients.