Clinical Detection Of Molecular Immune Components In Peripheral Blood And Hematoma Fluid Of Patients With Acute Cerebral Hemorrhage

ObjectiveIt is traditionally believed that inflammation associated hematoma disintegration products is one of the key factors leading to secondary brain injury after cerebral hemorrhage.However,recent studies have shown that some inflammatory factors may have immunosuppressive and neuroprotective effects in the pathophysiological process of cerebral hemorrhage.Although some studies have shown that the molecular immune system in the peripheral blood and hematoma fluid changes significantly after intracerebral hemorrhage,and this change will also affect the pathophysiological process of intracerebral hemorrhage.However,the relationship between the changes of the molecular immune system in the peripheral blood/hematoma fluid after cerebral hemorrhage and the clinical prognosis has not been systematically studied.To evaluate the relationship between the changes of molecular immune components in peripheral blood and hematoma fluid and clinical prognosis in patients with acute cerebral hemorrhage,this study tested the concentration of cytokines in peripheral blood and hematoma fluid after minimally invasive surgery(MIS)in patients with acute cerebral hemorrhage,and evaluated the correlation between the above molecular immune system changes and 90-day prognosis of patients with cerebral hemorrhage,in order to provide guidances for the treatment of patients with cerebral hemorrhage.MethodsFrom January 1,2016 to October 31,2017,35 patients with acute cerebral hemorrhage who underwent minimally invasive surgery(MIS)and met the admission criteria in the Fifth Affiliated Hospital of Zhengzhou University and People's Hospital of Gonyi were selected as ICH group,and 55 healthy people in the same period were selected as control group.After patients signing the informed consent,10 ml peripheral blood and 7-10 ml of hematoma fluid of each subject were collected within 30 hours after the onset of intracerebral hemorrhage.10 ml peripheral blood of each subject in control group was collected.The concentrations of IL-1??IL-6?IL-17?IL-23?TNF-??IL-4?IL-10 and TGF-? in peripheral blood and hematoma fluid were detected by enzyme-linked immunosorbent assay(ELISA).The time from onset to operation,lesion volume,NIHSS and Glasgow Coma Scale(GCS)of patients with cerebral hemorrhage were recorded.The neurological function score of 90 days after onset was recorded by telephone.Results1.Changes of molecular immune system after cerebral hemorrhage and correlation analysis of cytokine concentration and degree of brain injuryThe levels of IL-6,IL-17,IL-23,TNF-a,IL-4,IL-10 and TGF-? in peripheral blood of patients with cerebral hemorrhage were higher than those in the control group(p<0.05),the difference was statistically significant.The concentration of IL-1? in peripheral blood of the patients with cerebral hemorrhage was slightly lower than that of the control group [p=0.17,95% CI(-2.28-12.98)],and there was no significant difference between the two groups.The concentration of IL-1? and IL-10 in hematoma fluid of patients with cerebral hemorrhage was significantly lower than that in peripheral blood of patients with cerebral hemorrhage(p<0.05),and the difference was statistically significant.The concentration of TGF-? in hematoma fluid of patients with cerebral hemorrhage was higher than that of peripheral blood [p=0.043,95% CI(1.60-94.80)],and the difference was statistically significant.There was no correlation between the volume of cerebral hemorrhage and the concentration of cytokines in peripheral blood and hematoma fluid(p>0.05).The GCS was positively correlated with the concentration of IL-10(r=0.39,p=0.027)in the hematoma fluid,positively correlated with the time from onset to MIS(r=0.458,p=0.006),and negatively correlated with the NIHSS score at admission(r=-0.352,p=0.038).NIHSS score was positively correlated with age(r=0.484,p=0.003)and negatively correlated with GCS score(r=-0.352,p=0.038)at admission.After adjusting age and GCS score,NIHSS score was correlated with the marginal concentration of IL-4(r=0.33,p=0.057)in hematoma fluid.2.The relationship between changes of molecular immune system and prognosis of patients at 90 days after intracerebral hemorrhageThe age of patients with good prognosis was significantly younger than that of patients with poor prognosis.(56.4 years old and 67.7 years old;p=0.014),the NIHSS of patients with good prognosis was significantly lower than that of patients with poor prognosis(19 and 24;p=0.013).Compared with the poor prognosis group,the level of IL-10 in peripheral blood of patients with good prognosis was significantly higher than that of patients with poor prognosis(p<0.001),the concentration of IL-10 in hematoma fluid of patients with good prognosis was higher than that of patients with poor prognosis(p<0.05).Logistic regression analysis showed that the increase of IL-10 in peripheral blood(OR=0.97,p=0.045)and hematoma fluid(OR=0.93,p=0.039)may be related to the good prognosis of patients with cerebral hemorrhage at 90 days.Conclusions1.The concentration of cytokines in peripheral blood and hematoma fluid in patients with acute cerebral hemorrhage changed significantly.Some cytokines concentration has correlation with the GCS and NIHSS at admission.2.The changes of molecular immune system in peripheral blood and hematoma fluid of patients with acute cerebral hemorrhage may have predictive value for prognosis at 90 days.The increased concentration of IL-10 concentration in peripheral blood and hematoma fluid was independently related to the good prognosis at 90 days in patients with cerebral hemorrhage.