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Changes of TNF-α,IL-1β and cortisol in serum and hepatic GR following severe traumatic brain injury

QU Qiang,SHI Zhong△ (Department of Emergency,Xinqiao Hospital,Third Military Medical University,Chongqing 400037,China)  
Objective To observe the changes of TNF-α,IL-1β,ACTH,cortisol in serum and lymphocytic glucocorticoid resistant(GR) following severe traumatic brain injury(TBI).Methods The adult patients with severe TBI were randomly distributed to group Ⅰ(treated by ketamine and midazolam),group Ⅱ(no intervening) and group Ⅲ(normal contral).At 1h,2-4h,6-8h after TBI,ACTH,cytokine levels of TNF-α and IL-1β were measured by ELISA and radioimmuolgical assay(RIA),serum cortisol levels were determined,and total cytosolic GR in lymphocyte were detected with Western blotting.Results Serum ACTH,cortisol,TNF-α,IL-1β levels increased markedly,and there were two acmes in the observing curve.The lymphocytic GR was obviously down-regulated at protein levels after TBI,but only decreased more markedly in group Ⅱ than in group Ⅰ in Glasgow score 6-8 groups.Conclusion There is glucocorticoid resistant after severe TBI in human.There is inseparable relation of TNF-α and IL-1β.Ketamine and midazolam are apparently effective for reducing GR.
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