Fam Maged D, Zeineddine Hussein A, Eliyas Javed Khader, Stadnik Agnieszka, Jesselson Michael, McBee Nichol, Lane Karen, Cao Ying, Wu Meijing, Zhang Lingjiao, Thompson Richard E, John Sayona, Ziai Wendy, Hanley Daniel F, Awad Issam A
From the Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery (M.D.F., H.A.Z., J.K.E., A.S., M.J., Y.C., M.W., L.Z., Y.C., M.W., L.Z., I.A.A.), University of Chicago Medicine and Biological Sciences, IL; Brain Injury Outcomes (BIOS) Division, Department of Neurology (N.M., K.L., W.Z., D.F.H.), and The Bloomberg School of Public Health (R.E.T.), Johns Hopkins University Medical Institutions, Baltimore, MD; and Department of Neurology (S.J.), Rush University Medical Center, Chicago, IL.
Neurology. 2017 Oct 10;89(15):1553-1560. doi: 10.1212/WNL.0000000000004493. Epub 2017 Sep 8.
To investigate the temporal pattern and relevant associations of CSF inflammatory measures after intraventricular hemorrhage (IVH).
We analyzed prospectively collected CSF cell counts and protein and glucose levels from participants in the Clot Lysis Evaluation of Accelerated Resolution of IVH phase III (CLEAR III) trial. Corrected leukocyte count and cell index were calculated to adjust for CSF leukocytes attributable to circulating blood. Data were chronologically plotted. CSF inflammatory measures (daily, mean, median, maximum, and cases with highest quartile response) were correlated with initial IVH volume, IVH clearance rate, thrombolytic treatment, bacterial infection, and adjudicated clinical outcome at 30 and 180 days.
A total of 11,376 data points of CSF results from 464 trial participants were analyzed. Measures of CSF inflammatory response evolved during the resolution of IVH. This was significantly more pronounced with initial IVH volume exceeding 20 mL. Intraventricular alteplase was associated with a significantly augmented inflammatory response compared to saline, even after correcting for initial IVH volume. There was an association but nonpredictive correlation of CSF inflammation measures with culture-positive CSF bacterial infection. None of the CSF inflammatory measures, including cases with upper quartile inflammatory response, was associated with a significant detrimental effect on 30 or 180 days functional outcome or mortality after multivariate adjustment for measures of disease severity.
Aseptic CSF inflammation after IVH is primarily dependent on the volume of initial bleed. Thrombolysis intensifies the inflammatory response, with no apparent detrimental effect on clinical outcome.
NCT00784134.
研究脑室内出血（IVH）后脑脊液炎症指标的时间变化模式及相关关联。
我们分析了前瞻性收集的来自IVH加速溶解评估三期（CLEAR III）试验参与者的脑脊液细胞计数、蛋白质和葡萄糖水平。计算校正白细胞计数和细胞指数，以校正因循环血液导致的脑脊液白细胞。数据按时间顺序绘制。脑脊液炎症指标（每日、均值、中位数、最大值以及四分位数最高反应的病例）与初始IVH体积、IVH清除率、溶栓治疗、细菌感染以及30天和180天的判定临床结局相关。
共分析了464名试验参与者的11376个脑脊液结果数据点。脑脊液炎症反应指标在IVH消退过程中发生变化。初始IVH体积超过20 mL时，这种变化更为明显。与生理盐水相比，脑室内注射阿替普酶即使在校正初始IVH体积后仍与明显增强的炎症反应相关。脑脊液炎症指标与培养阳性的脑脊液细菌感染存在关联但无预测相关性。在对疾病严重程度指标进行多变量调整后，包括四分位数上炎症反应的病例在内，没有脑脊液炎症指标与30天或180天的功能结局或死亡率有显著的有害影响相关。
IVH后的无菌性脑脊液炎症主要取决于初始出血量。溶栓会加剧炎症反应，但对临床结局无明显有害影响。
NCT00784134。
