Osuka Koji, Ohmichi Yusuke, Ohmichi Mika, Nakura Takahiro, Iwami Kenichiro, Watanabe Yasuo, Miyachi Shigeru
Department of Neurological Surgery, Aichi Medical University, Aichi, Japan.
Department of Anatomy II, Kanazawa Medical University, Ishikawa, Japan.
J Neurotrauma. 2021 Jul 15;38(14):1979-1987. doi: 10.1089/neu.2020.7401. Epub 2021 Jan 27.
Chronic subdural hematoma (CSDH) is considered an angiogenic and inflammatory disease. Chemokines attract leukocytes, and invading neutrophils and monocytes/macrophages play important roles in wound healing. However, no studies have been reported regarding changes in expression of chemokines in CSDH fluid after trepanation surgery. We randomly divided patients who underwent trepanation surgery into two groups. One was the irrigation group, in which irrigation of CSDH fluids was performed and a drainage tube was placed ( = 10). The other was the non-irrigation group, in which a drainage tube was inserted without irrigation ( = 10). CSDH fluids were collected during the trepanation surgery, immediately after surgery and on day 1 through the drainage tube. The concentrations of interleukin-8 (IL-8), growth-regulated oncogene-α (GRO-α), epithelial neutrophil-activating peptide 78 (ENA-78), monocyte chemoattractant protein-1 (MCP-1), interferon-γ-induced protein-10 (IP-10), tissue plasminogen activator (tPA), von Willebrand factor (vWF), eotaxin-3, and myeloperoxidase (MPO) in each CSDH fluid sample were measured using enzyme-linked immunosorbent assay kits. After irrigation, concentrations of all chemokines decreased. However, concentrations of IL-8, GRO-α, ENA-78, MCP-1, and MPO were significantly increased on day 1 compared with concentrations during surgery with or without irrigation. In contrast, there were no changes in concentrations of IP-10, eotaxin-3, tPA, or vWF after trepanation surgery. Moreover, there were significant relationships among concentrations of IL-8, GRO-α, ENA-78, and MCP-1 during the surgery and on day 1. In CSDH fluids, chemokines that attract neutrophils, such as IL-8, GRO-α, ENA-78, and macrophage-attracting MCP-1, appear first after trepanation surgery, whereas lymphocyte-attracting IP-10 and eosinophil-attracting eotaxin-3 levels do not change within 1 day of surgery. These findings suggest that neutrophils and macrophages may play important roles in the healing process of CSDH at an early stage.
慢性硬膜下血肿（CSDH）被认为是一种血管生成性和炎症性疾病。趋化因子吸引白细胞，侵入的中性粒细胞和单核细胞/巨噬细胞在伤口愈合中起重要作用。然而，关于钻孔手术后CSDH液中趋化因子表达变化的研究尚未见报道。我们将接受钻孔手术的患者随机分为两组。一组为冲洗组，对CSDH液进行冲洗并放置引流管（n = 10）。另一组为非冲洗组，未进行冲洗直接插入引流管（n = 10）。在钻孔手术期间、手术后立即以及术后第1天通过引流管收集CSDH液。使用酶联免疫吸附测定试剂盒测量每个CSDH液样本中白细胞介素-8（IL-8）、生长调节致癌基因-α（GRO-α）、上皮中性粒细胞激活肽78（ENA-78）、单核细胞趋化蛋白-1（MCP-1）、干扰素-γ诱导蛋白10（IP-10）、组织型纤溶酶原激活剂（tPA）、血管性血友病因子（vWF）、嗜酸性粒细胞趋化因子-3和髓过氧化物酶（MPO）的浓度。冲洗后，所有趋化因子的浓度均降低。然而，与手术期间无论是否冲洗时的浓度相比，术后第1天IL-8、GRO-α、ENA-78、MCP-1和MPO的浓度显著升高。相比之下，钻孔手术后IP-10、嗜酸性粒细胞趋化因子-3、tPA或vWF的浓度没有变化。此外，手术期间和术后第1天IL-8、GRO-α、ENA-78和MCP-1的浓度之间存在显著相关性。在CSDH液中，吸引中性粒细胞的趋化因子，如IL-8、GRO-α、ENA-78和吸引巨噬细胞的MCP-1，在钻孔手术后首先出现，而吸引淋巴细胞的IP-10和吸引嗜酸性粒细胞的嗜酸性粒细胞趋化因子-3水平在手术1天内没有变化。这些发现表明，中性粒细胞和巨噬细胞可能在CSDH早期愈合过程中起重要作用。
