目的

探讨炎症反应与创伤性脊髓损伤（tSCI）严重程度及神经功能改善的关系。

方法

回顾性分析解放军南部战区海军第一医院神经外科自2020 年1 月至2023 年12 月收治的外伤性脊椎骨折合并脊髓损伤患者的临床资料，评估患者入院时和术后6个月时的AIS 分级，并收集入院时血液相关指标，包括血清白细胞（WBC）、中性粒细胞（NEUT）、中性粒细胞与淋巴细胞比值（NLR）及C 反应蛋白（CRP）等，根据入院时AIS 分级将患者分为A、B、C 和D 级，对比不同分级tSCI患者的炎症指标，并分析炎症指标与术后6个月神经功能改善的相关性。同时，为进一步证明tSCI中炎症反应的重要作用，通过GEO 数据库下载tSCI 相关数据集（GSE226238 和GSE151371），利用GEO2R筛选出差异表达基因（DEGs），并利用Metascape和KOBAS在线分析数据库对DEGs进行GO功能和KEGG 通路富集分析。

结果

AIS A 级患者的血清WBC、NEUT、NLR 及CRP 水平明显高于B 级、C 级及D 级患者，B 级患者的CRP 水平明显高于C 级与D 级患者，差异均有统计学意义（P＜0.05）。相关性分析显示，WBC、NEUT 和CRP 与术后6 个月的神经功能改善存在强相关性（Eta²=0.975、0.986、0.968，P＜0.05）。从GSE226238 和GSE151371 数据集中筛选出156 个差异共表达基因，其中14个为上调基因，142个为下调基因，基因功能富集和通路富集分析显示，这些基因主要富集在免疫/炎症相关过程中，包括细胞对细胞因子刺激的反应、NEUT 脱颗粒、急性/慢性炎症反应、调节WBC 增殖、免疫细胞的调节、PI3K-AKT 信号通路、细胞因子-细胞因子受体相互作用、Th17 细胞分化等。

结论

炎症反应与tSCI严重程度及神经功能改善密切相关，可能是决定tSCI术后功能改善的关键因素之一。

Objective

To explore the relationship between the inflammatory response and the severity and neurological improvement of traumatic spinal cord injury （tSCI）.

Methods

The clinical data of patients with traumatic spinal fractures and spinal cord injuries admitted to Neurosurgery Department of the First Naval Hospital of Southern Theater Command from January 2020 to December 2023 were analyzed. The AIS grading of patients at admission and 6 months after surgery was evaluated， and blood related indicators were collected at admission， including white blood cells （WBC）， neutrophils （NEUT），neutrophil to lymphocyte ratio （NLR）， and C-reactive protein （CRP）. Patients were classified into AIS grades A， B， C， and D according to the AIS grading at admission. The inflammatory indicators of patients with different grades of tSCI were compared， and the correlation between inflammatory indicators and neurological function improvement at 6 months after surgery was analyzed. At the same time， to further demonstrate the important role of inflammation response in tSCI， tSCI related datasets （GSE226238 and GSE151371） were downloaded from GEO database， differentially expressed genes （DEGs） were screened using GEO2R， and GO function and KEGG pathway enrichment analysis were performed on DEGs using Metascape and KOBAS online analysis databases.

Results

The serum levels of WBC，NEUT，NLR，and CRP in AIS grade A patients were significantly higher than those in grade B， C， and D， the CRP level in grade B patients was significantly higher than that in grade C and D patients， and the differences were statistically significant （P＜0.05）. Correlation analysis showed a strong correlation between WBC， NEUT，and CRP and improvement in neurological function at 6 months postoperatively（Eta²=0.975，0.986，0.968，P＜0.05）.A total of 156 differentially expressed genes were screened from the GSE226238 and GSE151371 datasets， including 14 upregulated genes and 142 downregulated genes. Gene function enrichment and pathway enrichment analysis showed that these genes were mainly enriched in immune/inflammation related processes， including cell response to cytokine stimulation， NEUT degranulation， acute/chronic inflammation response， regulation of WBC proliferation， regulation of immune cells， PI3K-AKT signaling pathway， cytokine - cytokine receptor interactions， and Th17 cell differentiation， etc..

Conclusion

Inflammatory response is closely related to tSCI severity and neurologic improvement， and may be one of the key factors determining functional improvement after tSCI.