Witkowska Anna Maria, Borawska Maria Halina, Socha Katarzyna, Kochanowicz Jan, Mariak Zenon, Konopka Maria
Department of Food Commodities Science and Technology, Medical University, Mieszka I4b, Białystok, Poland.
Arch Immunol Ther Exp (Warsz). 2009 Mar-Apr;57(2):137-40. doi: 10.1007/s00005-009-0010-4. Epub 2009 Apr 2.
Subarachnoidal hemorrhage (SAH) occurring after aneurysmal rupture produces an inflammatory response in the cerebral circulation. Tumor necrosis factor (TNF)-alpha is a major cytokine in this process. Adhesion molecules provide information on inflammatory reactions taking place in the walls of blood vessels. Clinical evidence suggests a role of soluble intercellular adhesion molecule (sICAM)-1 in early hemorrhagic events. This study aimed to evaluate the implementation of early TNF-alpha and sICAM-1 serum measurement for the prognosis of patient outcome after intracranial aneurysmal rupture.
The study consisted of 27 patients with a diagnosis of intracranial aneurysm. SAH was evaluated on admission according to the Fisher scale, patients' consciousness with the Glasgow Coma Scale, clinical grading with the Hunt and Hess scale, and clinical outcome with the Glasgow Outcome Scale (GOS). Blood samples were drawn within 72 h after arrival at the emergency room. Serum concentrations of TNF-alpha and sICAM-1 were assayed with the ELISA method.
The initial serum TNF-alpha concentration in the aneurysmal patients was low and did not correlate with radiological and clinical scores. The serum sICAM-1 level positively correlated with the severity of bleeding assessed by the Fisher scale and negatively with the patient's scoring in the GOS.
This study demonstrated the absence of a systemic TNF-alpha-mediated inflammatory response at the onset of subarachnoid hemorrhage. Early measurement of serum sICAM-1 levels offers a potential prognostic value in the assessment of patients' outcome after brain aneurysmal rupture.
动脉瘤破裂后发生的蛛网膜下腔出血（SAH）会在脑循环中引发炎症反应。肿瘤坏死因子（TNF）-α是这一过程中的主要细胞因子。黏附分子提供了有关血管壁炎症反应的信息。临床证据表明可溶性细胞间黏附分子（sICAM）-1在早期出血事件中发挥作用。本研究旨在评估早期检测血清TNF-α和sICAM-1对颅内动脉瘤破裂患者预后的评估价值。
本研究纳入了27例颅内动脉瘤患者。根据Fisher分级评估入院时的SAH情况，采用格拉斯哥昏迷量表评估患者意识，采用Hunt和Hess分级进行临床分级，采用格拉斯哥预后量表（GOS）评估临床结局。在到达急诊室后72小时内采集血样。采用ELISA法检测血清TNF-α和sICAM-1浓度。
动脉瘤患者的初始血清TNF-α浓度较低，且与影像学和临床评分无关。血清sICAM-1水平与Fisher分级评估的出血严重程度呈正相关，与GOS患者评分呈负相关。
本研究表明蛛网膜下腔出血发作时不存在全身性TNF-α介导的炎症反应。早期检测血清sICAM-1水平对评估脑动脉瘤破裂患者的预后具有潜在价值。
