Molecular signatures of brain injury after intracerebral hemorrhage
Molecular signatures of brain injury after intracerebral hemorrhage
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DOI：
10.1212/wnl.58.4.624
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发表时间：
2002-02-26
期刊：
影响因子：
9.9
通讯作者：
Kase, CS
中科院分区：
文献类型：
--
作者：
Castillo, J;Dávalos, A;Kase, CS
背景：脑出血（ICH）周围组织中细胞死亡的机制尚未明确。目的：探讨脑出血后兴奋性毒性和炎症标志物与脑损伤的关系。方法：前瞻性研究124例脑卒中24小时内入院的自发性脑出血患者。CT扫描测定颅内出血初始体积、第3 ~ 4天周围水肿、第3个月残余腔体体积。在入院时获得的血液样本中测量谷氨酸、细胞因子和粘附分子。卒中严重程度和神经系统预后用加拿大卒中量表进行评估。结果：53例（43%）患者观察到3个月时神经系统预后差（加拿大卒中量表< 7）。脑卒中严重程度和谷氨酸浓度（每增加10 μ mol/L，优势比1.23;95% CI 1.09至1.41）是预后不良的独立预测因子，但脑出血初始体积不是。多元线性回归分析中，肿瘤坏死因子-a浓度与血肿周围水肿体积相关（r = 0.83, p < 0.0001），谷氨酸浓度与残留腔体积相关（r = 0.78, p < 0.0001）。当分别分析大叶性脑出血（n = 58）和深部脑出血（n = 66）时，观察到相同的结果。结论：脑出血发生24小时内血浆促炎分子水平升高与随后血肿周围脑水肿的程度相关，而神经预后差和残留腔的体积与血浆谷氨酸浓度升高有关。
Background: The mechanisms of cellular death in the tissue surrounding an intracerebral hemorrhage (ICH) are not defined. Objective: To investigate the relationship of markers of excitotoxicity and inflammation to brain injury after ICH. Methods: A total of 124 consecutive patients with spontaneous ICH admitted within 24 hours of stroke onset were prospectively investigated. The volumes of the initial ICH, peripheral edema on days 3 to 4, and the residual cavity at 3 months were measured on CT scan. Glutamate, cytokines, and adhesion molecules were measured in blood samples obtained on admission. Stroke severity and neurologic outcome were evaluated with the Canadian Stroke Scale. Results: Poor neurologic outcome at 3 months (Canadian Stroke Scale < 7) was observed in 53 patients (43%). Stroke severity and glutamate concentrations (by each increment of 10 mumol/L, odds ratio 1.23; 95% CI 1.09 to 1.41), but not the initial volume of ICH, were independent predictors of poor outcome. In the multiple linear regression analyses, tumor necrosis factor-a concentration was correlated (r = 0.83, p < 0.0001) with the volume of perihematoma edema, and glutamate concentrations were correlated (r = 0.78, p < 0.0001) with the volume of the residual cavity. These same results were observed when lobar (n = 58) and deep (n = 66) ICH were analyzed separately. Conclusions: High plasma levels of proinflammatory molecules within 24 hours of intracerebral hemorrhage onset are correlated with the magnitude of the subsequent perihematoma brain edema, whereas poor neurologic outcome and the volume of the residual cavity are related to increased plasma glutamate concentrations.