The Clinical Study Of The Acute Intracerebral Hemorrhage Leading To SIRS Which Cause To MODS

Objective: To explore the possible mechanism of acute intracerebral hemorrhage which leading to systemic inflammatory response syndrome(SIRS) which cause to the multiple organ disfunction (MODS) and the morbidity of SIRS and MODS. This item dynamically observed the regulation of tumor necrosis factor alpha(TNF-a),Interleukin-10(IL-10),nitrogen monoxidumin (NO),C-reactive proteinserum(CRP),endotoxin(ETX)in serm of patients with simple acute intracerebral hemorrhage,acute intracerebral hemorrhage accompanied with SIRS and acute intracerebral hemorrhage accompanied with MODS,so as to investigate the significance of the mechanism in the acute intracerebral hemorrhage from SIRS to MODS,dignostic value and clinical significance,providing theory basis and laboratory index forearly preventing the happeness of MODS and judging the prognisis of acute intracerebral hemorrhage. Method: According to the diagnosis standard of SIRS and MODS ,we diagnostic the incidence rate of SIRS and MODS which caused by AICH.TNF-a was detected by the method of ELLISA.NO was detectedby the method of chemical colorimetric method.LPS was detected by limulus test.CRP was detected by the method of the automatic immune quantitative assay methods.Results:The incidence rate of acute intracerebral heorrhage accompanied with SIRS was 42.24%.The occurrence rate of cerebrovascular disease accompanied with MODS was 30.17%. The serum level of TNF- a,IL-10,CRP,ETX,NO in simple acute intracerebral hemorrhage group[(15.28±1.06)Pg/ml , (28.54±3.40)Pg/ml ,(73.77±1.93)μmol/L,(29.52±2.71)ng/L,(16.31±2.13)mg/L] was obviously higher than that in control group[(11.14±1.28)Pg/ml , (15.79±1.18)Pg/ml,(59.75±3.12)μmol/L,(20.17±1.66) ng/L,(5.33±0.49) mg/L] (P<0.05). Acute intracerebral heorrhage accompanied with SIRS group[(27.80±7.50)Pg/ml , (63.21±19.13)Pg/ml , (86.33±5.78)μmol/L ,(52.45±10.16) ng/L,(36.90±10.50)mg/L] was obviously higher than that in simple acute intracerebral heorrhage group and that in control group(P<0.05).Acute intracerebral heorrhage accompanied MODS group[(30.83±6.81)Pg/ml , (77.28±14.77)Pg/ml , (89.46±3.39)μmol/L ,(58.22±5.01) ng/L,(42.97±4.77)mg/L] was obviously higher than that in simple acute intracerebral heorrhage group,acute intracerebral heorrhage accompanied with SIRS group and in control group (P<0.05). The content of TNF- a,IL-10,CRP,ETX,NO in serum in the acute intracerebral heorrhage disease accompanied with MODS of various score group[(38.20±3.07)Pg/ml , (89.01±5.80)Pg/ml , (93.01±1.52)μmol/L ,(63.92±2.14) ng/L,(48.48±1.58)mg/L] is higher than that in the acute intracerebral heorrhage accompanied with SIRS group obviously(P<0.05),what'smore, in patients of acute intracerebral heorrhage accompanied with MODS, that in severe patients is higher than that in mild patients[(25.91±3.04)Pg/ml,(61.12±4.72)Pg/ml,(87.10±1.83)μmol/L,(54.43±1.34) ng/L , (39.30±1.309)mg/L] (P<0.05). Acute intracerebral heorrhage accompanied with MODS ,that in dead patients [(34.10±6.43)Pg/ml,(77.95±14.11)Pg/ml,(90.56±3.57)μmol/L,(60.10±5.01) ng/L,(44.91±4.60)mg/L]was obviously higher than that in the patients who was alive[(25.29±2.52)Pg/ml,(62.68±10.54)Pg/ml,(87.61±2.09)μmol/L,(55.04±3.10) ng/L,(39.70±3.01)mg/L] (P<0.05).There are significantly positive correlation between the score of MODS and the content of TNF- a the acute intracerebral heorrhageaccompanied with MODS (r= 0.933,P<0.01).There are significantly positive correlation between the score of MODS and the content of IL-10 in the acute intracerebral heorrhage accompanied with MODS(r=0.837,P<0.01). There are significantly positive correlation between the score of MODS and the content of NO in the acute intracerebral heorrhage accompanied with MODS(r=0.868,P<0.01). There are significantly positive correlation between the score of MODS and the content of ETX in the acute intracerebral heorrhage accompanied with MODS(r=0.789,P<0.01). There are significantly positive correlation between the score of MODS and the content of CRP in the acute intracerebral heorrhage accompanied with MODS. There are significantly positive correlation between the content of TNF- a and IL-10 that in the acute intracerebral heorrhage accompanied with SIRS group(r=0.866,P<0.01). There are significantly positive correlation between the content of TNF- a and IL-10 that in the acute intracerebral heorrhage accompanied with MODS group(r=0.848,P<0.01). There are significantly positive correlation between the content of CRP and TNF- a that in the acute intracerebral heorrhage accompanied with SIRS group(r=0.858,P<0.01). There are significantly positive correlation between the content of CRP and IL-10 that in the acute intracerebral heorrhage accompanied with SIRS group(r=0.927,P<0.01). There are significantly positive correlation between the content of CRP and TNF- a that in the acute intracerebral heorrhage accompanied with MODS group(r=0.901,P<0.01). There are significantly positive correlation between the content of CRP and IL-10 that in the acute intracerebral heorrhage accompanied with MODS group (r= 0.924,P<0.01).Conclusion:1.Acute intracerebral heorrhage could be accompanied with STRS,and could be the pathological basis of MODS after acute intracerebral heorrhage.2. TNF-a and IL-10 can initate excessive inflammatory reaction .NO is free radical and can cause significant injury to the brain .ETX is the beginning factor of the SIRS/MODS.CRP is the sensitive marker of the inflammatory reaction .All the facroes take part in the course of the SIRS/MODS caused by AICH.3. The serum level of TNF- a,IL-10,CRP,ETX,NO in acute intracerebral heorrhage accompanied with MODS group that in severe patients is higher than that in mild patients and there are significantly positive correlation between the score of MODS and the content of all factors in the acute intracerebral heorrhage accompanied with MODS.All the factors could be sensitive indexs for the pathogenetic condition and could be an early warning of the development of MODS.4.All the indexs could be sensitive index for juge the prognostic of the patients.5.TNF- a is phlemasia mediator and it could cause the delivery of IL-10 which is antiinflamtory mediator.6.CRP could be sensitive index of the SIRS/MODS.