Observation On The Changes Of Immune Indexes In Patients With Different Degrees Of Traumatic Brain Injury And Its Relationship With Prognosis

Objective:Traumatic brain injury is a common clinical disease.In recent years,despite the continuous updating of treatment methods,the mortality rate remains high.Studies have found that TBI patients have different degrees of immune dysfunction,which are closely related to the patient’s prognosis.However,which clinically commonly used immune index is more targeted for the prognosis of TBI needs to be further explored.At the same time,in the past,reports of changes in immune indicators of TBI patients were mostly limited to a single time point and were not classified,which could not fully reflect the changes in the body’s immune function after TBI.The purpose of this study is to dynamically observe the changes of immune indicators in patients with different severity of TBI in the acute phase,and on this basis to explore the predictive effect of each immune indicator on the prognosis of patients with STBI,in order to seek a new STBI prognostic indicator and provide a theoretical basis for immunotherapy and the timing of intervention for TBI patients.Method:Select 28 patients with mild(12 points<GCS score≤14 points),moderate(8 points<GCS score≤12 points),and severe head injury patients(GCS score≤8 points))who attended Yixing Hospital Affiliated to Jiangsu University from February 2020 to December 2020 as the research object.The immune function indicators of the three groups of patients on the 1,3,7,and 10 days after admission were measured,including the total number of lymphocytes,complement C3,complement C4,CD4~+,CD8~+,CD4~+/CD8~+,IgG,IgA.The immune indexes of the three groups of patients were statistically analyzed,One-way analysis of variance is used for comparison between groups and within groups.Patients with severe traumatic brain injury were divided into survival group and death group according to the prognosis of patients during the study period(14 days).Logistic regression analysis was performed on the immune indexes of patients in the survival group and the death group to explore the correlation between the immune indexes and the prognosis of patients.Result:1.Comparison between groups:The total number of lymphocytes in mild,moderate and severe TBI patients was statistically different on day 7(P<0.05),and the total number of lymphocytes was the lowest in severe group.The ratio of CD4~+/CD8~+on day10 was statistically different among the three groups,and the ratio of CD4~+/CD8~+was the lowest in the severe group.The CD8~+T cell level on day 10 is statistically significant in the comparison between mild,moderate and severe group while there were no statistically significant differences in other immune indexes among the light,medium and severe groups(P>0.05).2.Inter-group comparison:The total number of lymphocytes in the medium group on day 7 were statistically significant compared with those on days 1 and 3(P<0.05)and showed an overall upward trend;the IgG and IgA levels of the medium group and severe group increased from the first day to the tenth day,and the levels on day 10 were significantly higher than those on days 1 and 3(P<0.05);The levels of complement C3and complement C4 increased gradually in the severe group,and were statistically significant compared with those on the first day(P<0.05).CD4~+in the medium and heavy groups reached the highest value on the 7th day and then decreased,and the level was significantly higher than that on the 1st day(P<0.05).There was no significant difference in immune indexes over time in light group(P>0.05).3.Analysis of disease prognostic measures showed statistically significant differences in IgA,CD8~+,and CD4~+/CD8~+levels in patients with severe head injury on day 1 and day 3 after admission compared with patients who died(P<0.05).Logistic univariate analysis showed that CD4~+/CD8~+and IgA on day 3 were statistically different in the regression analysis(P<0.05),multivariate analysis showed no difference in CD4~+/CD8~+and IgA on day 3(P>0.05).Conclusion:1.In this study,the immune function of patients with mild TBI was not affected or only slightly affected.Patients with medium and severe TBI may have different degrees of immune dysfunction.The changes in lymphocyte count,CD4~+/CD8~+and CD8~+are the most obvious.2.Changes in CD4~+/CD8~+and IgA may have certain value in predicting the prognosis of patients with STBI,but they cannot be used as independent predictors.