The Study On The Change Of Cerebral Hemorrhage Periforcal Edema And Related Factors

Objective:To explore the change of cerebral hemorrhage perifocal edema and related factors.Methods:We registed 71 patients consecutively who met the inclusive criterias in The Second Affiliated Hospital of Henan University of Science and Technology from October 2008 to October 2009 and recorded the general condition, clinical characteristics, past history and neurological deficit situation. The head CT results at the time of admission,24h,72h,7d and 14d after admission were recorded. Hematoma and edema volume were measured and the neurological deficit was scored. Serum MMP-9, CRP, IL-6, TNF-a and C3 levels were detected in the 40 cerebral hemorrhage patients who met the inclusive criterias and 30 volunteers by radioimmunoassay at 24h,72h,7d and 14d after admission and the dynamic changes of the parameters mentioned above were analyzed in the process of perifocal edema. We used multivariate Logistic regression and variances analysis based on univariate analysis.Results:Cerebral edema peaked at 72h after admission, followed by a slow decline. Analysis revealed that hematoma volume had a significant effect on the edema volume (P<0.01). CT scan time and the bleeding site also had a significant effect (P<0.05). The interaction of bleeding site and scan time and the interaction of scan time and hematoma form were significantly affected the edema volume (P<0.05, P<0.01). The interaction among other factors had no significant effect. Within 24h after admission, serum MMP-9 and IL-6 levels increased significantly, peaked at 72h, in accordance with the peak of cerebral edema and decreased significantly after 7d. Serum MMP-9 and IL-6 were significantly higher than the control group (P＜0.01). The levels of MMP-9 and IL-6 decreased nearly to normal at 14d. The serum TNF-a peaked at 24h and then gradually decreased which was significantly higher than the control group at 24h and 72h after admission (P<0.01). MMP-9 were positively correlated with IL-6, TNF-a, CRP, hematoma volume, edema volume and edema ratio at 24h and 72h after admission (P<0.01). Serum IL-6 and TNF-a were positively correlated at 24h and 72h. IL-6 and the edema volume were positively correlated. TNF-a and edema volume were also positively correlated. Both IL-6 and TNF-a were positively correlated with CRP. IL-6 and TNF-a were also positively related with the edema volume at 7d and 14d. Complement C3 (g/L) showed no significant increase within 24h after admission, but increased from 24h to 72h. C3 (g/L) was correlated with hematoma volume, edema volume and edema ratio at 72h (P<0.01).Conclusions:Edema ratio reached the peak at 3d then decreased slowly. The interaction of bleeding site and scan time and the interaction of scan time and hematoma form were significantly affected the edema volume. Serum MMP-9, cytokines (IL-6, TNF-α), C3 changed dynamically after cerebral hemorrhage. Serum MMP-9 indicated the degree of perifocal edema in the early phase of cerebral hemorrhage. The excessive release of TNF-a may be an important factor in the formation of edema after cerebral hemorrhage. Serum MMP-9, IL-6 (pg/ml), TNF-a (pg/ml) and C3 (g/L) participated in the formation of perifocal edema and influenced each other.