Autoimmune responses to the brain after stroke are associated with worse outcome.
Autoimmune responses to the brain after stroke are associated with worse outcome.
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DOI：
10.1161/strokeaha.111.619593
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发表时间：
2011-10
期刊：
影响因子：
8.3
通讯作者：
Cain KC
中科院分区：
文献类型：
--
作者：
Becker KJ;Kalil AJ;Tanzi P;Zierath DK;Savos AV;Gee JM;Hadwin J;Carter KT;Shibata D;Cain KC
脑抗原的免疫反应发生在中风后，实验研究表明，中风时的全身炎症增加了对这些抗原产生有害自身免疫反应的可能性。本研究的目的是确定卒中后感染的患者是否同样易发生对中枢神经系统（CNS）抗原的自身免疫反应。我们招募了114名缺血性卒中72小时内的患者。获得临床和人口统计学数据，并在最初一周和第90天再次评估对一组CNS抗原的细胞免疫应答。采用改良的兰金量表评估结局。在卒中后15天内发生感染，尤其是肺炎的患者更可能在卒中后90天对髓鞘碱性蛋白（MBP）和胶质细胞酸性蛋白（分别为P=0.019和P=0.039）表现出TH 1（+）反应。此外，即使在调整基线卒中严重程度和患者年龄后，90天时对MBP更稳健的TH 1应答与良好结局的可能性降低相关（比值比= 0.477，95%CI = 0.244-0.935; P=0.031）。这项研究表明，脑抗原的免疫反应发生在中风后。虽然这些反应可能是缺血性脑损伤的附带现象，但对MBP的反应似乎具有临床后果。缺血后自身免疫介导的脑损伤的潜在作用值得进一步研究。
Immune responses to brain antigens occur after stroke, and experimental studies show that the likelihood of developing a detrimental autoimmune response to these antigens is increased by systemic inflammation at the time of stroke. The aim of this study was to determine if patients who developed infection in the post-stroke period would be similarly predisposed to develop autoimmune responses to central nervous system (CNS) antigens. We enrolled 114 patients within 72 hours of ischemic stroke. Clinical and demographic data were obtained, and cellular immune responses to a panel of CNS antigens were assessed during the initial week and again at day 90. Outcome was assessed using the modified Rankin Scale. Patients who developed an infection, especially pneumonia, in the 15 days after stroke were more likely to evidence a TH1(+) response to myelin basic protein (MBP) and glial fibrillary acidic protein (P=0.019 and P=0.039, respectively) at 90 days after stroke. Further, more robust TH1 responses to MBP at 90 days were associated with a decreased likelihood of good outcome, even after adjusting for baseline stroke severity and patient age (Odds Ratio = 0.477, 95% CI = 0.244–0.935; P=0.031). This study demonstrates that immune responses to brain antigens occur after stroke. And while these responses are likely to be an epiphenomenon of ischemic brain injury, the response to MBP appears to have clinical consequences. The potential role of post-ischemic autoimmune mediated brain injury deserves further investigation.