Bochkarev P Y, Berdyugina O V, Zhidkova V S, Zubova T E, Gusev E Y
Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia.
Regional Clinical Hospital No. 1, Ekaterinburg, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2020;120(8. Vyp. 2):24-29. doi: 10.17116/jnevro202012008224.
To identify the likelihood of developing systemic inflammation (SI) as a general pathological process in severe haemorrhagic intracerebral stroke with and without the phenomenon of ineffective cerebral blood flow.
Three groups were examined: 1) 89 blood donors (controls), 2) 15 patients with severe haemorrhagic stroke without the phenomenon of ineffective brain blood flow; 3) 26 patients with severe haemorrhagic stroke with ineffective cerebral blood flow. Ineffective cerebral blood circulation was recorded on the basis of transcranial Doppler ultrasound data; 87% of patients had clinical signs of brain death. All patients in the groups with haemorrhagic stroke had signs of multiple organ dysfunction according to the Sepsis-related Organ Failure scale, all of them received intensive care. An integrated scale based on the determination of plasma concentrations of cytokines (IL-6, IL-8, IL-10, TNF-α), procalcitonin, cortisol, D-dimers, myoglobin, troponin I was used to verify systemic inflammation.
Systemic inflammation or borderline state (pre-SI) was identified in all patients of the second group both on 1-3 days from the onset of haemorrhagic stroke, and on 5-8 days. On the contrary, in the third group, there were no signs of SI on 1-3 days. On 5-8 days, signs of SI and pre-SI were recorded only in 18.2% of patients. Apparently, the reason for these differences is the blockade of the passage of tissue decay products and other pro-inflammatory factors into the bloodstream from the damaged brain in the third group.
确定在伴有和不伴有脑血流无效现象的严重出血性脑中风中，发生全身炎症（SI）作为一种一般病理过程的可能性。
对三组进行了检查：1）89名献血者（对照组）；2）15名患有严重出血性中风且无脑血流无效现象的患者；3）26名患有严重出血性中风且伴有脑血流无效的患者。根据经颅多普勒超声数据记录脑血流无效情况；87%的患者有脑死亡的临床体征。出血性中风组的所有患者根据脓毒症相关器官衰竭量表均有多个器官功能障碍的体征，他们均接受了重症监护。使用基于测定细胞因子（IL-6、IL-8、IL-10、TNF-α）、降钙素原、皮质醇、D-二聚体、肌红蛋白、肌钙蛋白I血浆浓度的综合量表来验证全身炎症。
在第二组的所有患者中，在出血性中风发作后的1 - 3天以及5 - 8天均发现了全身炎症或临界状态（SI前期）。相反，在第三组中，1 - 3天没有SI的体征。在5 - 8天，仅18.2%的患者记录到了SI和SI前期的体征。显然，这些差异的原因是第三组中受损大脑的组织分解产物和其他促炎因子进入血流的通道被阻断。
