Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain.
PLoS One. 2013 Nov 4;8(11):e78429. doi: 10.1371/journal.pone.0078429. eCollection 2013.
Hyperthermia is a predictor of poor outcome in ischemic (IS) and intracerebral hemorrhagic (ICH) stroke. Our aim was to study the plausible mechanisms involved in the poor outcome associated to hyperthermia in stroke. We conducted a case-control study including patients with IS (n = 100) and ICH (n = 100) within the first 12 hours from symptom onset. Specifically, IS and ICH patients were consecutively included into 2 subgroups, according to the highest body temperature within the first 24 hours: Tmax <37.5°C and Tmax ≥37.5°C, up to reach 50 patients per subgroup of temperature for both IS and ICH patients. Body temperature was determined at admission and every 4 hours during the first 48 hours. Main outcome variable was poor functional outcome (modified Rankin scale score >2) at 3 months. Serum levels of glutamate and active MMP-9 were measured at admission. Our results showed that Tmax ≥37.5°C within the first 24 hours was independently associated with poor outcome in both IS (OR, 12.43; 95% CI, 3.73-41.48; p<0.0001) and ICH (OR, 4.29; 95% CI, 1.32-13.91; p = 0.015) after adjusting for variables with a proven biological relevance for outcome. However, when molecular markers levels were included in the logistic regression model, we observed that glutamate (OR, 1.01; 95% CI, 1.00-1.02; p = 0.001) and infarct volume (OR, 1.06; 95% CI, 1.01-1.10; p = 0.015) were the only variables independently associated to poor outcome in IS, and active MMP-9 (OR, 1.04; 95% CI, 1.00-1.08; p = 0.002) and National Institute of Health Stroke Scale (NIHSS) at admission (OR, 1.29; 95% CI, 1.13-1.49; p<0.0001) in ICH. In conclusion, these results suggest that although the outcome associated to hyperthermia is similar in human IS and ICH, the underlying mechanisms may be different.
高热是缺血性脑卒中（IS）和脑出血（ICH）患者预后不良的预测因素。我们的目的是研究与脑卒中高热相关的不良预后的可能涉及的机制。我们进行了一项病例对照研究，纳入了发病后 12 小时内的 IS（n=100）和 ICH（n=100）患者。具体来说，根据发病后 24 小时内的最高体温，将 IS 和 ICH 患者连续分为 2 个亚组：Tmax<37.5°C 和 Tmax≥37.5°C，每个亚组温度范围内各纳入 50 名患者。入院时和前 48 小时内每 4 小时测量一次体温。主要转归变量为发病 3 个月时的不良功能结局（改良 Rankin 量表评分>2）。入院时测量谷氨酸和活性 MMP-9 的血清水平。我们的结果显示，发病后 24 小时内 Tmax≥37.5°C 与 IS（OR，12.43；95%CI，3.73-41.48；p<0.0001）和 ICH（OR，4.29；95%CI，1.32-13.91；p=0.015）的不良预后独立相关，在调整了与预后具有已知生物学相关性的变量后仍有意义。然而，当将分子标志物水平纳入逻辑回归模型时，我们发现谷氨酸（OR，1.01；95%CI，1.00-1.02；p=0.001）和梗死体积（OR，1.06；95%CI，1.01-1.10；p=0.015）是 IS 不良预后的唯一独立相关因素，而活性 MMP-9（OR，1.04；95%CI，1.00-1.08；p=0.002）和入院时的国立卫生研究院卒中量表（NIHSS）评分（OR，1.29；95%CI，1.13-1.49；p<0.0001）是 ICH 不良预后的独立相关因素。总之，这些结果表明，尽管高热与人类 IS 和 ICH 的预后相关，但潜在的机制可能不同。
