Righy Cássia, Turon Ricardo, Freitas Gabriel de, Japiassú André Miguel, Faria Neto Hugo Caire de Castro, Bozza Marcelo, Oliveira Marcus F, Bozza Fernando A
Laboratório de Pesquisa Clínica em Medicina Intensiva, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brasil.
Rev Bras Ter Intensiva. 2018 Mar;30(1):21-27. doi: 10.5935/0103-507x.20180003. Epub 2018 Mar 15.
To evaluate the relationships of brain iron and heme with the inflammatory response of the systemic and central nervous systems and to investigate the role of defensive systems against the toxicity of iron and heme in the central nervous system.
We assessed a prospective cohort of patients presenting with intracerebral and subarachnoid hemorrhage. We assayed plasma and cerebrospinal fluid samples for the presence of iron, heme, hemopexin, haptoglobin, enolase, S100-β and cytokines for the first three days following hemorrhagic stroke. We also analyzed the dynamic changes in these components within both fluids and their relationship with early mortality rates.
Hemopexin and haptoglobin concentrations were nearly negligible in the brain after intracerebral and subarachnoid hemorrhage. Cerebrospinal fluid iron and heme concentrations correlated with a pro-inflammatory response in the central nervous system, and plasmatic and cerebrospinal fluid inflammatory profiles on the third day after hemorrhagic stroke were related to early mortality rates. Interleukin 4 levels within the cerebrospinal fluid during the first 24 hours after hemorrhagic stroke were found to be higher in survivors than in non-survivors.
Iron and heme are associated with a pro-inflammatory response in the central nervous system following hemorrhagic stroke, and protections against hemoglobin and heme are lacking within the human brain. Patient inflammatory profiles were associated with a poorer prognosis, and local anti-inflammatory responses appeared to have a protective role.
评估脑铁和血红素与全身及中枢神经系统炎症反应的关系，并研究中枢神经系统中铁和血红素毒性防御系统的作用。
我们评估了一组患有脑内出血和蛛网膜下腔出血的前瞻性队列患者。在出血性中风后的头三天，我们检测了血浆和脑脊液样本中的铁、血红素、血红素结合蛋白、触珠蛋白、烯醇化酶、S100-β和细胞因子。我们还分析了这些成分在两种液体中的动态变化及其与早期死亡率的关系。
脑内出血和蛛网膜下腔出血后，脑中血红素结合蛋白和触珠蛋白浓度几乎可以忽略不计。脑脊液中铁和血红素浓度与中枢神经系统的促炎反应相关，出血性中风后第三天的血浆和脑脊液炎症谱与早期死亡率相关。出血性中风后24小时内，幸存者脑脊液中的白细胞介素4水平高于非幸存者。
铁和血红素与出血性中风后中枢神经系统的促炎反应相关，人脑内缺乏针对血红蛋白和血红素的保护机制。患者的炎症谱与较差的预后相关，局部抗炎反应似乎具有保护作用。
