Brain interstitial fluid TNF-alpha after subarachnoid hemorrhage.
Brain interstitial fluid TNF-alpha after subarachnoid hemorrhage.
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DOI：
10.1016/j.jns.2009.12.023
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发表时间：
2010-04-15
影响因子：
4.4
通讯作者：
Badjatia, Neeraj
中科院分区：
文献类型：
--
作者：
Hanafy, Khalid A.;Grobelny, Bartosz;Fernandez, Luis;Kurtz, Pedro;Connolly, E. S.;Mayer, Stephan A.;Schindler, Christian;Badjatia, Neeraj
关键词：
TNF-α是一种炎性细胞因子，在促进导致炎症反应的事件级联中发挥核心作用。最近的研究表明，TNF-α可能在脑动脉瘤的形成和破裂中起关键作用，并且潜在的脑炎症反应是蛛网膜下腔出血（SAH）后结局的主要决定因素。我们研究了14名昏迷的SAH患者，他们接受了颅内压（ICP）和脑微透析的多模态神经监测作为其临床护理的一部分。每8小时对连续生理变量进行一次时间锁定，并在脑微透析样本中测量脑间质液TNF-α的同一时间点进行记录。使用广义估计方程确定显著相关性。在平均72小时的监测中，每例患者平均获得9次脑组织TNF-α测量值。TNF-α水平随时间逐渐升高。脑间质TNF-α升高的预测因素包括脑间质液葡萄糖水平升高（β=0.066，P<0.02）、脑室内出血（β=0.085，P<0.021）和动脉瘤大小>6 mm（β=0.14，P<0.001）。TNF-α水平与脑池SAH负荷之间无相关性;同时测量血清葡萄糖或乳酸-丙酮酸比值。SAH后脑间质TNF-α水平升高，并与动脉瘤尺寸大、脑室内血液负担和脑间质葡萄糖水平升高相关。
TNF-α is an inflammatory cytokine that plays a central role in promoting the cascade of events leading to an inflammatory response. Recent studies have suggested that TNF-α may play a key role in the formation and rupture of cerebral aneurysms, and that the underlying cerebral inflammatory response is a major determinate of outcome following subrarachnoid hemorrhage (SAH). We studied 14 comatose SAH patients who underwent multimodality neuromonitoring with intracranial pressure (ICP) and cerebral microdialysis as part of their clinical care. Continuous physiological variables were time-locked every 8 hours and recorded at the same point that brain interstitial fluid TNF-α was measured in brain microdialysis samples. Significant associations were determined using generalized estimation equations. Each patient had a mean of 9 brain tissue TNF-α measurements obtained over an average of 72 hours of monitoring. TNF-α levels rose progressively over time. Predictors of elevated brain interstitial TNF-α included higher brain interstitial fluid glucose levels (β=0.066, P<0.02), intraventricular hemorrhage (β=0.085, P<0.021), and aneurysm size >6 mm (β=0.14, p<0.001). There was no relationship between TNF-α levels and the burden of cisternal SAH; concurrent measurements of serum glucose, or lactate-pyruvate ratio. Brain interstitial TNF-α levels are elevated after SAH, and are associated with large aneurysm size, the burden of intraventricular blood, and elevation brain interstitial glucose levels.
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影响因子：
3.5
作者：
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