Early Dynamics of Interleukin-6 in Cerebrospinal Fluid after Aneurysmal Subarachnoid Hemorrhage
Early Dynamics of Interleukin-6 in Cerebrospinal Fluid after Aneurysmal Subarachnoid Hemorrhage
复制标题
DOI：
10.1055/s-0037-1604084
复制
发表时间：
2018-03-01
影响因子：
1
通讯作者：
Smrcka, Martin
中科院分区：
文献类型：
--
作者：
Duris, Kamil;Neuman, Eduard;Smrcka, Martin
蛛网膜下腔出血（SAH）是一种严重的疾病，死亡率高。早期脑损伤（EBI）在SAH的病理生理学中起着重要作用，而炎症是EBI的主要贡献者。炎症是实验和临床条件下广泛研究的主题;然而，只有少数临床研究主要集中在SAH后的早期炎症反应，缺乏有关早期炎症反应动力学与主要临床特征之间相关性的详细信息。本研究分析了SAH后炎症反应的早期动力学，并评估早期炎症反应的标志物和主要临床特征之间的可能关联。患者和方法在过去的24小时内，共47例诊断为蛛网膜下腔出血患者参加了这项研究。所有治疗，包括动脉瘤治疗（手术/弹簧圈栓塞术）和引流系统植入（脑室外引流/腰椎导管），均以与其他诊断为该疾病的患者相同的方式进行。每天三次采集血液和脑脊液（CSF）样本，持续4天。采用线性混合效应模型分析SAH患者脑脊液中IL-6、IL-1、TNF水平与SAH主要临床特征的关系在随后的阶段（72小时后），IL-6水平增加，但IL-6水平的变异性很高。格拉斯哥结局量表评分与IL-6总体水平（p =0.0095）及其动力学（p =0.0208）之间存在显著相关性; Hunt和Hess量表的影响处于临界状态（p =0.0887）。未发现IL-6水平与Fisher分级、治疗方式（手术、弹簧圈栓塞术、不治疗）和脑血管痉挛的后期发展之间存在关联。IL-6的血浆水平略有增加，但没有显着的关联被发现。IL-1和TNF的水平均在生理范围内的CSF和plasma.Conclusions CSF中IL-6的早期动态与患者的结果。但由于IL-6的高度变异性，很难单独使用IL-6进行结果预测。问题是IL-6的动态是否可以与其他与脑损伤相关的早期标志物联合使用。需要更详细的研究来回答这个问题。
Background Subarachnoid hemorrhage (SAH) is a severe condition associated with high mortality. Early brain injury (EBI) plays an important role in the pathophysiology of SAH, and inflammation is a major contributor to EBI. Inflammation is a widely studied topic in both experimental and clinical conditions; however, just a few clinical studies have focused primarily on the early inflammatory response after SAH, and detailed information about the association between the dynamics of early inflammatory response with main clinical characteristics is lacking. This study analyzes the early dynamics of inflammatory response after SAH and evaluates the possible associations between the markers of early inflammatory response and main clinical characteristics.Patients and Methods A total of 47 patients with a diagnosis of aneurysmal SAH within the last 24 hours were enrolled in the study. All treatments, including treatment of aneurysm (surgery/coiling) and implantation of a drainage system (external ventricular drainage/lumbar catheter), were conducted in the same way as in other patients with this diagnosis. Blood and cerebrospinal fluid (CSF) samples were collected three times a day for 4 days. The dynamics of proinflammatory cytokines were assessed, and associations between levels of the proinflammatory cytokines interleukin (IL)-6, IL-1, or tumor necrosis factor (TNF) and main clinical characteristics were evaluated using linear mixed-effect models.Results The CSF levels of IL-6 were massively increased initially after SAH (up to 72 hours) with an additional increase in later phases (after 72 hours), but there was high variability in IL-6 levels. A significant association was noted between the Glasgow Outcome Scale score and both overall levels of IL-6 ( p =0.0095) and their dynamics ( p =0.0208); the effect of the Hunt and Hess scale was borderline ( p =0.0887). No association was found between IL-6 levels and Fisher grade, modality of treatment (surgery, coiling, no treatment), and later development of cerebral vasospasm. Plasmatic levels of IL-6 increased slightly, but no significant association was found. The levels of IL-1 and TNF were within the physiologic range in both CSF and plasma.Conclusions Early dynamics of IL-6 in CSF are associated with a patient's outcome. But it is difficult to use IL-6 alone for outcome prediction due to its high variability. The question is whether the dynamics of IL-6 could be used in combination with other early markers associated with brain injury. More detailed research is required to answer this question.