Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao Sung district, Kaohsiung 83304, Taiwan.
Crit Care. 2011;15(6):R284. doi: 10.1186/cc10568. Epub 2011 Nov 25.
Serum concentrations of adhesion molecules may be connected to the pathogenesis of secondary brain injury after spontaneous intracerebral hemorrhage (ICH). This study posits the hypothesis that levels of adhesion molecules substantially increase after ICH and are decreased thereafter, and that they can predict treatment outcomes.
Two hundred and thirty-nine blood samples were collected from 60 consecutive patients admitted within 24 hours after onset of spontaneous ICH and 60 blood samples were collected from 60 volunteers. Additional samples were obtained on Days 4, 7, 10, and 14 after onset of ICH regardless of clinical deterioration.
Upon discharge, the therapeutic outcomes of the 60 spontaneous ICH cases based on the modified Rankin Disability Scale (mMRS) showed that 17 had no disability while 8.3% developed delayed cerebral infarction (DCI). Statistical analysis of adhesion molecules between patient groups with good outcome (mMRS = 0 or 1) and poor outcome (mMRS ≥2) revealed significant differences in diabetes mellitus (P=0.049), hyperlipidemia (P=0.012), mentality change (P=0.043), ICH volume and intraventricular hemorrhage on admission (P=0.036 and 0.006, respectively), Glasgow Coma Scale (GCS) on admission (P≤0.001), neuro-surgical intervention (P=0.003), and sE-selectin and soluble intercellular cell adhesion-molecule-1 (sICAM-1) levels on admission (P=0.036 and 0.019, respectively). Multiple logistic regression analysis of these significant variables showed that GCS on admission, hyperlipidemia, and sICAM-1 (P=0.039, 0.042, and 0.022, respectively) were independently associated with outcome of acute spontaneous ICH.
Increased sICAM-1 and sE-selectin levels may imply poor therapeutic outcomes for the treatment of spontaneous ICH during hospitalization. These early inflammatory responses may cause whole-brain injury immediately after spontaneous ICH and offer a potential therapeutic target for such patients. The importance of these findings is that they offer a potential therapeutic target for patients with spontaneous ICH.
血清黏附分子浓度可能与自发性脑出血（ICH）后继发性脑损伤的发病机制有关。本研究提出假设，即黏附分子水平在 ICH 后显著升高，随后降低，并且可以预测治疗结果。
对 60 例发病 24 小时内入院的连续自发性 ICH 患者采集 239 份血样，对 60 例志愿者采集 60 份血样。ICH 发病后第 4、7、10、14 天无论临床恶化与否均采集额外样本。
根据改良 Rankin 残疾量表（mMRS），60 例自发性 ICH 患者出院时的治疗结果显示，17 例无残疾，8.3%发生迟发性脑梗死（DCI）。对预后良好（mMRS=0 或 1）和预后不良（mMRS≥2）患者组的黏附分子进行统计学分析，发现糖尿病（P=0.049）、高脂血症（P=0.012）、神志改变（P=0.043）、入院时 ICH 体积和脑室内出血（P=0.036 和 0.006）、入院时格拉斯哥昏迷量表（GCS）评分（P≤0.001）、神经外科干预（P=0.003）以及 sE-选择素和可溶性细胞间黏附分子-1（sICAM-1）水平（P=0.036 和 0.019）存在显著差异。对这些有显著差异的变量进行多因素逻辑回归分析，发现入院时 GCS、高脂血症和 sICAM-1（P=0.039、0.042 和 0.022）与急性自发性 ICH 的预后独立相关。
sICAM-1 和 sE-选择素水平升高可能意味着自发性 ICH 住院期间治疗效果不佳。这些早期炎症反应可能导致自发性 ICH 后全脑损伤，并为这类患者提供潜在的治疗靶点。这些发现的重要性在于，它们为自发性 ICH 患者提供了一个潜在的治疗靶点。
