Bernstein Jacob E, Savla Paras, Dong Fanglong, Zampella Bailey, Wiginton James G, Miulli Dan E, Wacker Margaret R, Menoni Rosalinda
Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA.
Osteopathy, College of Osteopathic Medicine - Touro University, Vallejo, USA.
Cureus. 2018 Oct 31;10(10):e3529. doi: 10.7759/cureus.3529.
Background and purpose The pathogenesis of brain injury after intracerebral hemorrhage is thought to be due to mechanical damage followed by ischemic, cytotoxic, and inflammatory changes in the underlying and surrounding tissue.In recent years, there has been a greater research interest into the various inflammatory biomarkers and growth factors that are secreted during intracerebral hemorrhage. The biomarkers investigated in this study are tumor necrosis factor alpha (TNF alpha), C-reactive protein (CRP), homocysteine (Hcy), and vascular endothelial growth factor (VEGF). The aim of this study was to further investigate the effects of these biomarkers in predicting the acute severity outcome of intracerebral hemorrhage (ICH). Methods We conducted a retrospective chart review of patients with spontaneous ICH with TNF alpha, CRP, VEGF, and Hcy levels drawn on admission. Forty-two patients with spontaneous ICH with at least one of the above labs were included in the study. Primary outcomes included death, Glasgow Coma Scale (GCS) on admission, early neurologic decline (END), and hemorrhage size. Secondary outcomes included GCS on discharge, ICH score, functional outcome risk stratification scale of intracerebral hemorrhage (FUNC score), change in hemorrhage size, need for surgical intervention, and length of intensive care unit (ICU) stay. Results Forty-two patients with spontaneous intracerebral hemorrhage (ICH) were analyzed, 12 patients (28.5%) required surgical intervention, and four patients (9.5%) died. Only low VEGF serum values were found to predict mortality. TNF alpha, CRP, Hcy, and VEGF levels in our patients with ICH were not found to predict early neurologic decline and were not correlated with GCS on admission, initial hemorrhage size, change in hemorrhage size, need for surgical intervention, ICH score, FUNC score, midline shift, and length of ICU stay. CRP and Hcy were elevated in 58% and 31% of patients tested, respectively. GCS on admission and ICH score were significantly associated with mortality. Conclusion After careful statistical review of the data obtained from this patient population, only low VEGF values were found to be a significant predictor of mortality. However, elevated CRP and Hcy levels were associated with a non-significant trend in hemorrhage size and mortality suggesting that CRP and Hcy-lowering therapies may decrease hemorrhagic stroke risk and severity.
背景与目的 脑出血后脑损伤的发病机制被认为是由于机械损伤，随后在其下方及周围组织发生缺血、细胞毒性和炎症变化。近年来，对脑出血期间分泌的各种炎症生物标志物和生长因子的研究兴趣日益浓厚。本研究中所调查的生物标志物为肿瘤坏死因子α（TNFα）、C反应蛋白（CRP）、同型半胱氨酸（Hcy）和血管内皮生长因子（VEGF）。本研究的目的是进一步研究这些生物标志物在预测脑出血（ICH）急性严重程度结局方面的作用。方法 我们对入院时检测了TNFα、CRP、VEGF和Hcy水平的自发性ICH患者进行了回顾性病历审查。42例至少检测了上述一项指标的自发性ICH患者纳入研究。主要结局包括死亡、入院时格拉斯哥昏迷量表（GCS）评分、早期神经功能恶化（END）和出血大小。次要结局包括出院时GCS评分、ICH评分、脑出血功能结局风险分层量表（FUNC评分）、出血大小变化、手术干预需求以及重症监护病房（ICU）住院时间。结果 对42例自发性脑出血（ICH）患者进行了分析，12例患者（28.5%）需要手术干预，4例患者（9.5%）死亡。仅发现低VEGF血清值可预测死亡率。未发现ICH患者的TNFα、CRP、Hcy和VEGF水平可预测早期神经功能恶化，且与入院时GCS评分、初始出血大小、出血大小变化、手术干预需求、ICH评分、FUNC评分、中线移位及ICU住院时间均无相关性。检测的患者中，分别有58%和31%的患者CRP和Hcy升高。入院时GCS评分和ICH评分与死亡率显著相关。结论 在对该患者群体获得的数据进行仔细的统计学审查后，仅发现低VEGF值是死亡率的显著预测指标。然而，CRP和Hcy水平升高与出血大小和死亡率的非显著趋势相关，提示降低CRP和Hcy的治疗可能降低出血性卒中的风险和严重程度。
