Department of Neurosurgery, University of Texas Health Science Center at Houston-McGovern Medical School, 6431 Fannin St, Houston, TX, 77030, USA.
Neurocrit Care. 2018 Apr;28(2):203-211. doi: 10.1007/s12028-017-0471-y.
Early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH) is defined as brain injury occurring within 72 h of aneurysmal rupture. Although EBI is the most significant predictor of outcomes after aSAH, its underlying pathophysiology is not well understood. We hypothesize that EBI after aSAH is associated with an increase in peripheral inflammation measured by cytokine expression levels and changes in associations between cytokines.
aSAH patients were enrolled into a prospective observational study and were assessed for markers of EBI: global cerebral edema (GCE), subarachnoid hemorrhage early brain edema score (SEBES), and Hunt-Hess grade. Serum samples collected at ≤ 48 h of admission were analyzed using multiplex bead-based assays to determine levels of 13 pro- and anti-inflammatory cytokines. Pairwise correlation coefficients between cytokines were represented as networks. Cytokine levels and differences in correlation networks were compared between EBI groups.
Of the 71 patients enrolled in the study, 17 (24%) subjects had GCE, 31 (44%) subjects had SEBES ≥ 3, and 21 (29%) had HH ≥ 4. IL-6 was elevated in groups with GCE, SEBES ≥ 3, and HH ≥ 4. MIP1β was independently associated with high-grade SEBES. Correlation network analysis suggests higher systematic inflammation in subjects with SEBES ≥ 3.
EBI after SAH is associated with increased levels of specific cytokines. Peripheral levels of IL-10, IL-6, and MIP1β may be important markers of EBI. Investigating systematic correlations in addition to expression levels of individual cytokines may offer deeper insight into the underlying mechanisms related to EBI.
动脉瘤性蛛网膜下腔出血（aSAH）后的早期脑损伤（EBI）定义为在动脉瘤破裂后 72 小时内发生的脑损伤。尽管 EBI 是 aSAH 后结局的最显著预测因素，但它的潜在病理生理学尚未得到很好的理解。我们假设 aSAH 后的 EBI 与通过细胞因子表达水平测量的外周炎症增加以及细胞因子之间的关联变化有关。
将 aSAH 患者纳入前瞻性观察性研究，并评估 EBI 的标志物：全脑水肿（GCE）、蛛网膜下腔出血早期脑水肿评分（SEBES）和 Hunt-Hess 分级。入院后≤48 小时采集的血清样本使用多重珠粒基于检测分析来确定 13 种促炎和抗炎细胞因子的水平。细胞因子之间的成对相关系数表示为网络。比较 EBI 组之间细胞因子水平和相关网络的差异。
在纳入本研究的 71 名患者中，17 名（24%）患者有 GCE，31 名（44%）患者 SEBES≥3，21 名（29%）患者 HH≥4。IL-6 在 GCE、SEBES≥3 和 HH≥4 组中升高。MIP1β 与高级别 SEBES 独立相关。相关网络分析表明，SEBES≥3 的患者全身炎症反应更高。
aSAH 后的 EBI 与特定细胞因子水平升高有关。外周 IL-10、IL-6 和 MIP1β 水平可能是 EBI 的重要标志物。除了单个细胞因子的表达水平外，研究系统相关性可能会深入了解与 EBI 相关的潜在机制。
