Measurement of Inflammatory Cytokines and Thrombomodulin in Chronic Subdural Hematoma
Measurement of Inflammatory Cytokines and Thrombomodulin in Chronic Subdural Hematoma
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DOI：
10.2176/nmc.52.810
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发表时间：
2012-11-01
影响因子：
1.9
通讯作者：
Teramoto, Akira
中科院分区：
文献类型：
--
作者：
Kitazono, Masatoshi;Yokota, Hiroyuki;Teramoto, Akira
炎症和凝血系统可能影响慢性硬膜下血肿（CSDH）的发生。CSDH在CT上的表现随血肿的分期而变化。本研究通过比较2004年10月至2006年11月在我院接受单钻孔手术的26例患者（共34例CSDH）的细胞因子水平和CSDH的CT特征，研究了CSDH的发病机制和复发情况。检查手术过程中清除的血肿成分，并测量血肿血清中的细胞因子水平，如血栓调节蛋白（TM）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF α）和白细胞介素-10（IL-10）。使用CT将混合密度血肿与其他均匀血肿区分开来，发现混合密度血肿的TM水平显著高于均匀血肿（p = 0.043）。混合密度血肿分为三种亚型（层状、分离性和小梁状血肿）。TM水平在层状和分离血肿中显著高于其他血肿（p = 0.01）。IL-6、TNF α和IL-10的水平极高，但与CT特征无关。如前所述，混合密度血肿的复发率较高，混合密度血肿（如层状和分离的混合密度血肿）的TM水平较高。目前的研究结果表明，与高TM水平相关的CSDH类型往往有较高的复发率。
Inflammation and the coagulation system may influence the genesis of chronic subdural hematoma (CSDH). The appearance of CSDH on computed tomography (CT) varies with the stage of the hematoma. This study investigated the pathogenesis and the recurrence of CSDH by comparing cytokine levels with the CT features of CSDH in 26 patients with 34 CSDHs who underwent single burr-hole surgery at our hospital between October 2004 and November 2006. The hematoma components removed during the procedure were examined, and the hematoma serum levels of cytokines measured such as thrombomodulin (TM), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF alpha), and interleukin-10 (IL-10). Using CT, mixed density hematomas were distinguished from other homogeneous hematomas, and found that the TM level was significantly higher in mixed density hematomas than in homogeneous hematomas (p = 0.043). Mixed density hematomas were classified into three subtypes (laminar, separated, and trabecular hematomas). The TM level was significantly higher in laminar and separated hematomas than in other hematomas (p = 0.01). The levels of IL-6, TNFa, and IL-10 were extremely high, but showed no significant differences in relation to the CT features. Mixed density hematomas had high recurrence rate, as reported previously, and TM level was high in mixed density hematomas such as laminar and separated mixed density hematomas. The present findings suggest that the types of CSDH associated with high TM levels tend to have higher recurrence rate.