Division of Critical Care Neurology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
J Neurol Sci. 2010 Apr 15;291(1-2):69-73. doi: 10.1016/j.jns.2009.12.023. Epub 2010 Jan 27.
TNF-alpha is an inflammatory cytokine that plays a central role in promoting the cascade of events leading to an inflammatory response. Recent studies have suggested that TNF-alpha may play a key role in the formation and rupture of cerebral aneurysms, and that the underlying cerebral inflammatory response is a major determinate of outcome following subrarachnoid hemorrhage (SAH).
We studied 14 comatose SAH patients who underwent multimodality neuromonitoring with intracranial pressure (ICP) and cerebral microdialysis as part of their clinical care. Continuous physiological variables were time-locked every 8h and recorded at the same point that brain interstitial fluid TNF-alpha was measured in brain microdialysis samples. Significant associations were determined using generalized estimation equations.
Each patient had a mean of 9 brain tissue TNF-alpha measurements obtained over an average of 72h of monitoring. TNF-alpha levels rose progressively over time. Predictors of elevated brain interstitial TNF-alpha included higher brain interstitial fluid glucose levels (beta=0.066, p<0.02), intraventricular hemorrhage (beta=0.085, p<0.021), and aneurysm size >6mm (beta=0.14, p<0.001). There was no relationship between TNF-alpha levels and the burden of cisternal SAH; concurrent measurements of serum glucose, or lactate-pyruvate ratio.
Brain interstitial TNF-alpha levels are elevated after SAH, and are associated with large aneurysm size, the burden of intraventricular blood, and elevation brain interstitial glucose levels.
TNF-α 是一种炎症细胞因子，在促进炎症反应级联反应中起着核心作用。最近的研究表明，TNF-α 可能在脑动脉瘤的形成和破裂中起关键作用，而潜在的脑炎症反应是蛛网膜下腔出血（SAH）后结局的主要决定因素。
我们研究了 14 例昏迷的 SAH 患者，他们在临床治疗中接受了多模式神经监测，包括颅内压（ICP）和脑微透析。连续的生理变量每 8 小时锁定一次，并在脑微透析样本中测量脑间质 TNF-α 的同一时间点记录。使用广义估计方程确定显著关联。
每位患者平均有 9 次脑实质 TNF-α 测量，监测时间平均为 72 小时。TNF-α 水平随时间逐渐升高。脑间质 TNF-α 升高的预测因素包括脑间质葡萄糖水平较高（β=0.066，p<0.02）、脑室出血（β=0.085，p<0.021）和动脉瘤大小>6mm（β=0.14，p<0.001）。TNF-α 水平与脑池 SAH 的负担、血清葡萄糖或乳酸丙酮酸比值无相关性。
SAH 后脑间质 TNF-α 水平升高，与大动脉瘤大小、脑室血液负担以及脑间质葡萄糖水平升高有关。
