Relationship between brain interstitial fluid tumor necrosis factor-α and cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
Relationship between brain interstitial fluid tumor necrosis factor-α and cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
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DOI：
10.1016/j.jocn.2009.11.041
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发表时间：
2010-07
影响因子：
2
通讯作者：
Schindler, Christian
中科院分区：
文献类型：
--
作者：
Hanafy, Khalid A.;Stuart, R. Morgan;Khandji, Alexander G.;Connolly, E. Sander;Badjatia, Neeraj;Mayer, Stephan A.;Schindler, Christian
关键词：
肿瘤坏死因子-α（TNF-α）在溶血诱导的血管损伤和脑血管收缩的发生中起关键作用。我们假设从脑间质液中测得的TNF-α与蛛网膜下腔出血（aSAH）后血管痉挛的严重程度相关。方法与结果：对连续10例接受脑微透析（MD）并通过CT血管造影（CTA）或数字减影血管造影（DSA）评估血管痉挛的aSAH患者，从aSAH第4-6天开始，采用酶联免疫吸附试验（ELISA）每隔8小时测定MD中的TNF-α水平。一名对研究不知情的神经放射科主治医师独立评价了每项CTA和DSA，并分配了血管痉挛指数（VI）。5例患者的VI< 2 and 5 patients had a VI >> 2，中位VI为2（范围0-18）。VI < 2组的中位对数TNF-α曲线下面积（AUC）为1.64 pg/mL* 天（四分位距1.48-1.71），VI > 2组为2.11 pg/mL* 天（四分位距1.95-2.47）（p < 0.01）。结论：在这一小部分低分级aSAH患者中，aSAH第4-6天的TNF-α水平AUC与放射学血管痉挛的严重程度相关。根据我们的初步发现，有必要在更大的人群中进行进一步分析。
Tumor necrosis factor-α (TNF-α) has a crucial role in the onset of hemolysis-induced vascular injury and cerebral vasoconstriction. We hypothesized that TNF-α measured from brain interstitial fluid would correlate with the severity of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). Methods and results: From a consecutive series of 10 aSAH patients who underwent cerebral microdialysis (MD) and evaluation of vasospasm by CT angiogram (CTA) or digital subtraction angiography (DSA), TNF-α levels from MD were measured at 8-hour intervals from aSAH days 4–6 using enzyme-linked immunosorbent assay. An attending neuroradiologist blinded to the study independently evaluated each CTA and DSA and assigned a vasospasm index (VI). Five patients had a VI < 2 and 5 patients had a VI > 2, where the median VI was 2 (range 0–18). The median log TNF-α area under the curve (AUC) was 1.64 pg/mL*day (interquartile range 1.48–1.71) for the VI < 2 group, and 2.11 pg/mL*day (interquartile range 1.95–2.47) for the VI > 2 group (p < 0.01). Conclusion: In this small series of poor-grade aSAH patients, the AUC of TNF-α levels from aSAH days 4–6 correlates with the severity of radiographic vasospasm. Further analysis in a larger population is warranted based on our preliminary findings.
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