Role of angiogenic growth factors and inflammatory cytokine on recurrence of chronic subdural hematoma
Role of angiogenic growth factors and inflammatory cytokine on recurrence of chronic subdural hematoma
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DOI：
10.1016/j.surneu.2008.01.023
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发表时间：
2009-02-01
影响因子：
--
通讯作者：
Kim, Jac-Min
中科院分区：
文献类型：
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作者：
Hong, Hyun-Jong;Kim, Young-Jin;Kim, Jac-Min
背景：慢性硬膜下血肿是一种良性疾病，手术治疗已确立，但偶尔会复发。在本文中，我们评估的作用，局部炎症和血管生成的复发CSH通过测量相关的生化因子从surgical samples.Methods：在2年的时间内，进行了前瞻性比较研究，对66例连续CSH谁经历了相同的一个钻孔引流程序。术中收集硬膜下积液和外膜并保存。在硬膜下液中，VEGF、bFGF和IL-6的浓度通过ELISA技术测定。外膜免疫组化染色，半定量分析。所有数据在有和无复发的患者之间进行比较。52名未复发患者的硬膜下积液中IL-6、VEGF和bFGF的平均浓度分别为1980.2 ± 229.1、8262.1 ± 971.9和8.6 ± 1.4 pg/mL，而14名复发患者的平均浓度为2411.3 ± 446.7，分别为9646.0 +/- 793.3和9.8 +/- 2.6 pg/mL。复发组IL-6水平明显高于未复发组，而VEGF和bFGF水平无明显差异。免疫组化染色显示复发患者外膜VEGF和bFGF的表达明显强于未复发患者，而IL-6的表达则无明显差异。当CSH患者在初次手术时硬膜下液中IL-6浓度较高或外膜中VEGF和bFGF表达增强时，复发的可能性更大，因此必须进行必要的后续评价。关于复发，局部炎症似乎是负责持续出血的毛细血管渗出在早期阶段，而血管生成似乎使成熟的外膜发芽血管网络在后期阶段。(C)2009 Elsevier Inc. All rights reserved.
Background: Chronic subdural hematoma, a benign illness with established surgical treatment, occasionally presents as an annoying recurrence. In this paper, we assess the role of local inflammation and angiogenesis on the recurrence of CSH by measuring relevant biochemical factors from surgical specimens.Methods: During a 2-year period, a prospective comparative study was conducted on 66 consecutive patients with CSH Who underwent the same one burr-hole drainage procedure. In the initial operation, the subdural fluid and Outer membrane were collected and stored. In the subdural fluid, concentrations of VEGF, bFGF, and IL-6 were measured by the ELISA technique. And semiquantitative analyses were performed with the outer membrane, which was stained by an immunohistochemical method. All data were compared between patients with and without recurrence.Results: The mean concentrations of IL-6, VEGF, and bFGF in subdural fluid in 52 nonrecurrent patients were 1980.2 +/- 229.1, 8262.1 +/- 971.9, and 8.6 +/- 1.4 pg/mL, whereas those in 14 recurrent patients were 2411.3 +/- 446.7, 9646.0 +/- 793.3, and 9.8 +/- 2.6 pg/mL, respectively. Concentration of IL-6 was significantly higher in recurrent patients than in nonrecurrent patients, but no significant differences were found in VEGF and bFGF concentrations. Immunohistochemical staining of the outer membrane showed significantly stronger staining of the VEGF and bFGF in recurrent patients than in those without recurrence, but not of the IL-6.Conclusions: When patients with CSH exhibit higher concentrations of IL-6 in the subdural fluid, or enhanced expression of VEGF and bFGF in the Outer membrane at the initial operation, recurrence is more likely to occur and a precautious follow-up evaluation is mandated. With regard to the recurrence, local inflammation seems to be responsible for continuous bleeding by capillary exudation in the earlier phase, whereas angiogenesis appears to render maturation of the outer membrane by sprouting vascular networks in the later phase. (C) 2009 Elsevier Inc. All rights reserved.