Ma Chunxiao, Zhou Wei, Yan Zhaoyue, Qu Mingqi, Bu Xingyao
Department of Neurosurgery, Henan Provincial People's Hospital.
Neurol Med Chir (Tokyo). 2015;55(12):878-84. doi: 10.2176/nmc.oa.2015-0077. Epub 2015 Oct 6.
In the present prospective study, the Toll-like receptor 4 (TLR4) levels on peripheral blood mononuclear cells (PBMCs) were investigated in 30 patients with aneurysmal subarachnoid hemorrhage (aSAH) and in 20 healthy controls (HCs). The relationship between TLR4 levels and the occurrence of cerebral vasospasm (CVS) was also analyzed. TLR4 expression level on cell surface of PBMCs on days 1, 3, and 7 after admission was determined by flow cytometry. Results showed that patients with aSAH presented a significantly higher TLR4 levels. For patients with Hunt-Hess grades IV-V, higher TLR4 levels were also observed; higher TLR4 levels have already been seen in patients developing CVS and/or delayed cerebral ischemia (DCI). Higher TLR4 levels were also associated with modified Fisher score, occurrence of dCVS, DCI, cerebral infarction (CT), and poor neurological functional recovery. Binary logistic regression analysis indicated that high TLR4 expression on blood monocytes was an independent predictive factor of the occurrence of dCVS, DCI, and poor neurological functional recovery. Taken together, TLR4 levels on PBMCs is significantly altered in the early stage of aSAH, especially in those patients experiencing CVS and DCI. Furthermore, higher TLR4 levels in the early stage of aSAH is also associated with the neurological function outcome. As far as we know, this is the first clinical study about TLR4's significance for patients with aSAH.
在本前瞻性研究中，对30例动脉瘤性蛛网膜下腔出血（aSAH）患者和20例健康对照者（HCs）外周血单个核细胞（PBMCs）上的Toll样受体4（TLR4）水平进行了研究。还分析了TLR4水平与脑血管痉挛（CVS）发生之间的关系。采用流式细胞术测定入院后第1、3和7天PBMCs细胞表面的TLR4表达水平。结果显示，aSAH患者的TLR4水平显著更高。对于Hunt-Hess分级为IV-V级的患者，也观察到较高的TLR4水平；在发生CVS和/或延迟性脑缺血（DCI）的患者中已经观察到较高的TLR4水平。较高的TLR4水平还与改良Fisher评分、迟发性CVS、DCI、脑梗死（CT）以及神经功能恢复不良有关。二元逻辑回归分析表明，血液单核细胞上高TLR4表达是迟发性CVS、DCI和神经功能恢复不良发生的独立预测因素。综上所述，aSAH早期PBMCs上的TLR4水平显著改变，尤其是在那些发生CVS和DCI的患者中。此外，aSAH早期较高的TLR4水平也与神经功能结局相关。据我们所知，这是第一项关于TLR4对aSAH患者意义的临床研究。
