Neurological Service, San Camillo de Lellis General Hospital, Rieti, Italy.
Neurology. 2012 Aug 14;79(7):690-9. doi: 10.1212/WNL.0b013e318264e3be. Epub 2012 Aug 1.
We examined the C-reactive protein (CRP) response after spontaneous intracerebral hemorrhage (sICH) and its relationship to outcome. We additionally characterized early brain localization of CRP.
In this prospective, multicenter, international, collaborative, longitudinal study with cross-sectional immunohistochemical analysis of brain tissue, 223 patients (M/F: 132/91) were recruited during the 2010 calendar year. CRP was evaluated at admission (median 93 minutes from symptom onset), 24 hours, 48 hours, and 72 hours after sICH. Brains of 5 subjects with sICH were compared to brains of 2 aged controls without evidence of brain pathology and 7 patients with ischemic stroke. Plasma CRP was measured over 72 hours following sICH and its relationship to 30-day mortality and functional outcome at 30 days (Glasgow Outcome Scale) was determined. CRP immunostaining patterns were analyzed in samples of sICH autopsy brains.
Plasma CRP increased over the 48 hours from admission and was significantly (p < 0.001) related to hematoma volume at later time points. The predictive utility of CRP for morbidity and mortality were maintained when adjusted for other risk factors and improved at 48 hours and 72 hours when compared with admission values. Although an early CRP localization was present in both ischemic and hemorrhagic lesions, an intense and diffuse neuropil staining was only present in sICH patients and particularly evident proximal to the hemorrhagic areas.
Plasma CRP production increases markedly over the 48 hours to 72 hours period following sICH and is related to outcome. CRP is also present in large amounts around the hemorrhagic lesion and within neurons and glia of patients who died within 12 hours of sICH.
研究自发性脑出血（sICH）后 C 反应蛋白（CRP）的反应及其与预后的关系。我们还对 CRP 的早期脑定位进行了特征描述。
在这项前瞻性、多中心、国际、协作、纵向研究中，对脑组织进行了横断面免疫组织化学分析，共招募了 223 名患者（M/F：132/91），在 2010 年日历年内。入院时（症状发作后中位数 93 分钟）评估 CRP，24 小时、48 小时和 72 小时后进行 sICH。将 5 例 sICH 患者的大脑与 2 例无脑部病理证据的年龄对照组和 7 例缺血性卒中患者的大脑进行比较。在 sICH 后 72 小时内测量血浆 CRP，并确定其与 30 天死亡率和 30 天功能结局（格拉斯哥结局量表）的关系。分析了 sICH 尸检大脑样本中的 CRP 免疫染色模式。
入院后 48 小时内，血浆 CRP 升高，与血肿体积在后期显著相关（p<0.001）。当调整其他危险因素时，CRP 对发病率和死亡率的预测能力得以维持，并在 48 小时和 72 小时时与入院值相比有所提高。虽然缺血和出血性病变中均存在早期 CRP 定位，但只有在 sICH 患者中才存在强烈且弥漫性的神经突染色，并且在出血区域附近尤为明显。
sICH 后 48 小时至 72 小时，血浆 CRP 产生量显著增加，与预后相关。CRP 在出血性病变周围以及在 sICH 后 12 小时内死亡的患者的神经元和神经胶质细胞中也大量存在。
