The release of tumor necrosis factor-α is associated with ischemic tolerance in human stroke
The release of tumor necrosis factor-α is associated with ischemic tolerance in human stroke
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DOI：
10.1002/ana.10765
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发表时间：
2003-12-01
影响因子：
11.2
通讯作者：
Dávalos, A
中科院分区：
文献类型：
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作者：
Castillo, J;Moro, MA;Dávalos, A
肿瘤坏死因子（TNF）-α过度表达与脑梗死前短暂缺血时的实验性缺血耐受有关。我们调查了283例症状发作后24小时内急性卒中患者的TNF-α和白细胞介素（IL）-6血浆浓度。在38例患者中记录了卒中前72小时内的同侧短暂性脑缺血发作（TIA）。有TIA病史的患者在第4 - 7天通过计算机断层扫描测量的梗死体积和3个月时不良结局（Barthel指数评分< 85）的频率显著较低。在有TIA病史的患者中，TNF-α的血浆浓度较高（42.5 +/- 9.9 vs 13.1 +/- 6.4 pg/ml，p < 0.0001），IL-6水平较低（10.1 +/- 6.2 vs 28.3 +/- 17.3 pg/ml，p < 0.0001）。当TNF-α大于30 pg/ml且IL-6小于30 pg/ml时，称为TNF-α/IL-6指数的新变量被认为是阳性的。在92%有TIA病史的患者中发现TNF-α/IL-6指数阳性，而在1%无TIA病史的患者中发现TNF-α/IL-6指数阳性。在调整潜在混杂因素后，逻辑回归分析显示，TNF-alpha/IL-6指数（p = 0.0003）和TIA（p = 0.0001）与良好结局相关。急性卒中中的缺血耐受与IL-6浓度降低时TNF-α血浆水平升高相关。
Tumor necrosis factor (TNF)-alpha overexpression has been related to experimental ischemic tolerance when transient ischemia precedes cerebral infarction. We investigated TNF-alpha and interleukin (IL)-6 plasma concentrations in 283 patients with an acute stroke within 24 hours after symptom onset. An ipsilateral transient ischemic attack (TIA) within 72 hours before stroke was recorded in 38 patients. The infarct volume measured on computed tomography on days 4 to 7 and the frequency of poor outcome (Barthel Index score < 85) at 3 months were significantly lower in patients with prior TIA. Plasma concentrations of TNF-alpha were higher (42.5 +/- 9.9 vs 13.1 +/- 6.4 pg/ml, p < 0.0001) and IL-6 levels were lower (10.1 +/- 6.2 vs 28.3 +/- 17.3 pg/ml, p < 0.0001) in patients with prior TIA. A new variable termed TNF-alpha/IL-6 index was considered positive when TNF-alpha was greater than 30 pg/ml and IL-6 was less than 30 pg/ml. Positive TNF-alpha/IL-6 index was found in 92% of patients with prior TIA and in 1% of those without. TNF-alpha/IL-6 index (p = 0.0003) and TIA (p = 0.0001) were associated with good outcome in logistic regression analysis after adjusting for potential confounding factors. Ischemic tolerance in acute stroke is associated with increased plasma levels of TNF-alpha in the presence of reduced concentrations of IL-6.