Utrecht Stroke Center, Rudolf Magnus Institute of Neuroscience, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands.
Neurocrit Care. 2011 Dec;15(3):405-9. doi: 10.1007/s12028-011-9556-1.
The pathogenesis of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) remains obscure. The authors assessed the relationship of tumor necrosis factor alpha (TNF-α) and TNF-α gene polymorphisms with occurrence of DCI and poor outcome at 3 months.
Serum levels of TNF-α were measured every other day until discharge in 67 patients and the mean serum levels per patient during days 0-12 were dichotomized at the median value of the whole group. TNF-α genotyping was available in 31 patients and related to serum TNF-α by means of one-way ANOVA analysis. The authors calculated hazard ratio's (HR) with corresponding 95% confidence intervals (CI) for the association with DCI by means of Cox proportional hazard analysis and odds ratio's (OR) for the association with poor clinical outcome by means of logistic regression analysis. In both analyses the authors adjusted for sex, age, amount of blood, and clinical condition at admission. Leukocytes and CRP were investigated similarly for comparison.
For high-serum TNF-α levels during days 0-12 adjusted HR was 0.6 (95%CI: 0.1-2.4) for DCI and adjusted OR 2.0 (95%CI: 0.4-9.0) for clinical outcome. Serum TNF-α levels were 11.4 pg/ml for wildtype TNF-α genotype and 9.7 pg/ml for the non-wildtype TNF-α genotype (P = 0.15). For the non-wildtype TNF-α genotype the HR for DCI was 0.4 (95%CI: 0.1-2.6) and the OR for clinical outcome was 0.8 (95%CI: 0.1-4.0).
It is unlikely that serum TNF-α or TNF-α genotype play an important role in the occurrence of DCI after SAH.
蛛网膜下腔出血（SAH）后迟发性脑缺血（DCI）的发病机制仍不清楚。作者评估了肿瘤坏死因子-α（TNF-α）和 TNF-α 基因多态性与 DCI 的发生和 3 个月时不良预后的关系。
对 67 例患者每隔一天测量血清 TNF-α 水平，直到出院，并将患者的平均血清水平在第 0-12 天的中位数进行二分法。对 31 例患者进行 TNF-α 基因分型，并通过单因素方差分析将 TNF-α 基因型与血清 TNF-α 相关联。作者通过 Cox 比例风险分析计算与 DCI 相关的风险比（HR）及其相应的 95%置信区间（CI），并通过逻辑回归分析计算与不良临床结果相关的比值比（OR）。在这两种分析中，作者均根据性别、年龄、出血量和入院时的临床状况进行了调整。白细胞和 CRP 也进行了类似的调查以作比较。
在调整了第 0-12 天的血清 TNF-α 水平后，高血清 TNF-α水平的 DCI 的调整 HR 为 0.6（95%CI：0.1-2.4），临床结局的调整 OR 为 2.0（95%CI：0.4-9.0）。野生型 TNF-α 基因型的血清 TNF-α 水平为 11.4pg/ml，非野生型 TNF-α 基因型的血清 TNF-α 水平为 9.7pg/ml（P=0.15）。非野生型 TNF-α 基因型的 DCI 的 HR 为 0.4（95%CI：0.1-2.6），临床结局的 OR 为 0.8（95%CI：0.1-4.0）。
血清 TNF-α 或 TNF-α 基因型不太可能在 SAH 后 DCI 的发生中起重要作用。
