Proinflammatory cytokines and early neurological worsening in ischemic stroke
Proinflammatory cytokines and early neurological worsening in ischemic stroke
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DOI：
10.1161/01.str.31.10.2325
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发表时间：
2000-10-01
期刊：
影响因子：
8.3
通讯作者：
Chamorro, A
中科院分区：
文献类型：
--
作者：
Vila, N;Castillo, J;Chamorro, A
背景和目的--缺血性中风患者临床恶化的机制尚不完全清楚。几种促炎细胞因子在脑缺血发作后早期释放，但目前尚不清楚炎症是否会导致神经恶化。我们评估了白细胞介素6和肿瘤坏死因子-α在缺血性卒中早期神经功能恶化中的意义。方法：231例首次发病24小时内连续入院的缺血性脑梗塞患者。当入院后48小时内加拿大卒中量表(CSS)得分下降至少1分时，定义为神经恶化。测定入院时血浆和脑脊液(n=81)中IL-6和TNF-α的含量。结果：83例(35.9%)患者在入院后48小时内病情恶化。多因素Logistic回归分析显示，血浆IL-6水平(21.5pg/mL；OR37.7，CI11.9~118.8)或脑脊液(>；6.3pg/mL；OR13.1，CI2.2~77.3)是早期临床恶化的独立危险因素，其相关性在所有缺血性卒中亚型及皮质或皮质下梗死组中均有统计学意义。血浆IL-6水平与体温、血糖、纤维蛋白原、脑梗塞体积高度相关，脑脊液和血浆中肿瘤坏死因子-α浓度在病情恶化时也较高，但经多因素分析差异无统计学意义。结论入院时IL-6水平除参与局灶性脑缺血后的急性期反应外，还与早期临床恶化有关。IL-6与早期神经恶化之间的联系是普遍存在的，而与缺血性梗塞的初始大小、地形或机制无关。
Background and Purpose-The mechanisms for clinical deterioration in patients with ischemic stroke are not completely understood. Several proinflammatory cytokines are released early after the onset of brain ischemia, but it is unknown whether inflammation predisposes to neurological deterioration. We assessed the implication of interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha in early neurological worsening in ischemic stroke.Methods-Two hundred thirty-one patients consecutively admitted with first-ever ischemic cerebral infarction within the first 24 hours from onset were included. Neurological worsening was defined when the Canadian Stroke Scale (CSS) score fell at least 1 point during the first 48 hours after admission. IL-6 and TNF-alpha were determined in plasma and cerebrospinal fluid (CSF; n=81) obtained on admission.Results-Eighty-three patients (35.9%) deteriorated within the first 48 hours. IL-6 in plasma (>21.5 pg/mL; OR 37.7, CI 11.9 to 118.8) or in CSF (>6.3 pg/mL; OR 13.1, CI 2.2 to 77.3) were independent factors for early clinical worsening with multiple logistic regression, The association was statistically significant in all ischemic stroke subtypes as well as in subjects with cortical or subcortical infarctions. IL-6 in plasma was highly correlated with body temperature, glucose, fibrinogen, and infarct volume, CSF and plasma concentrations of TNF-alpha were also higher in patients who deteriorated, bur the differences observed did not remain significant on multivariate analysis.Conclusions-In addition to participating in the acute-phase response that follows focal cerebral ischemia, IL-6 levels on admission an associated with early clinical deterioration. The association between IL-6 and early neurological worsening prevails without regard to the initial size, topography, or mechanism of the ischemic infarction.