Clinical Research About HMGB1 Participating The Cerebral Vasospasm After Aneurismal Subarachnoid Hemorrhage

Objective To confirm the role of high-mobility group box 1 and its cytokine downstream interleukin-6, interleukin-8, interleukin-1β, tumor necrosis factor a, monocyte chemoattractant protein-1 in the development of cerebral vasospasm and clinical outcome.Methods Forty-two patients with acute aSAH were selected in the study, they are all chosen from the department of neurosurgery of Nanjing Drum Tower Hospital during October 2014 to March 2015. Seurm was collected on the admission day and 1, 3,5,7, day after surgery, and levels of HMGB1, IL-6, IL-8, IL-10, TNF-α, MCP-1 were measured. Patients did 1.5T MRI scans within 5 to 14 days after surgery and follow-up the outcomes after a month. Patients were divided into CVS group and Non-CVS group according to the existence of SCVS and MRI result. The comparative study was performed.Result 1 Compared with Non-CVS group, levels of HMGB1, IL-6, IL-8, TNF-α and MCP-1 of CVS group in serum were significantly increased at all time points (P<0.05, statistically significant), and the values peaked at the first day after surgery, then decreased gradually.2 HMGB1 correlated significantly with IL-6 and IL-8 (P<0.05, statistically significant), TNF-α and MCP-1 are correlated positively with HMGB 1 but had not statistically significant (P>0.05).3 Patients who suffered poor outcomes (mRS>4) were all in CVS group, levels of HMGB 1, IL-8, TNF-α and MCP-1 were significantly increased compared with those who had good outcomes (P<0.05, statistically significant), IL-6 was increased as well but had not statistically significant (P>0.05).4 According to the ROC curves, HMGB 1, IL-6 and TNF-α had clinical significance in the diagnosis of CVS (P<0.05, statistically significant), the best diagnostic threshold values were 74.13μg/L,4.67 pg/mL and 2.82 pg/mL each. HMGB1, IL-6, IL-8, TNF-α and MCP-1 had clinical significance in the diagnosis of poor outcomes (P<0.05, statistically significant), the best diagnostic threshold values were 86.82μg/L,13.33 pg/mL,13.27 pg/mL,2.86 pg/mL and 160.51 pg/mL each.5 The values of 1L-1β in serum were extremely low, and can not be analyzed statistically.Conclusion The level of HMGB1 and the cytokine downstream IL-6, IL-8, TNF-α, MCP-1 have relationships with the development of CVS and the poor clinical outcomes. As a DAMP release from necrotic cells, HMGB 1 involves in inflammation and may can be the biomarker of predicting CVS and poor outcomes.