急性脑出血患者脑组织中小胶质细胞/巨噬细胞极化状态与血肿周围水肿的关系

Association between polarization status of microglia/macrophage in brain tissue and edema around hematoma in patients with acute cerebral hemorrhage

目的探讨急性脑出血患者脑组织中小胶质细胞/巨噬细胞(MG/MP)极化状态与血肿周围水肿的相关性。方法选择2020年12月至2022年11月安阳市人民医院收治的急性脑出血患者52例为研究对象。所有患者行骨瓣开颅血肿清除术,获取手术通道上未受血肿侵犯的皮质区正常脑组织和血肿周围的破碎脑组织(血肿周围脑组织),采用Western blot法检测脑组织中炎症因子白细胞介素(IL)-1β、IL-6、肿瘤坏死因子-α(TNF-α)、IL-10、转化生长因子-β(TGF-β)的蛋白表达水平,采用荧光定量聚合酶链反应检测脑组织中IL-1β、IL-6、TNF-α、IL-10、TGF-β的mRNA表达水平,采用免疫荧光共聚焦技术检测脑组织中M1型、M2型MG/MP水平。收集患者手术前的CT影像资料,计算血肿周围相对水肿体积(r-PHE),根据r-PHE将患者分为高r-PHE组(2.0≤r-PHE<2.5)和低r-PHE组(1.5<r-PHE<2.0)。比较高r-PHE组与低r-PHE组患者血肿周围脑组织中IL-1β、IL-6、TNF-α、IL-10和TGF-β的mRNA相对表达量。结果血肿周围脑组织中IL-1β、IL-6、TNF-α蛋白和mRNA相对表达量显著高于正常脑组织(P<0.05);血肿周围脑组织与正常脑组织中IL-10、TGF-β蛋白和mRNA相对表达量比较差异无统计学意义(P>0.05)。血肿周围脑组织中M1型MG/MP和M2型MG/MP水平均显著高于正常脑组织(P<0.05)。高r-PHE组患者血肿周围脑组织中IL-1β、IL-6、TNF-α的mRNA相对表达量显著高于低r-PHE组(P<0.05);2组患者血肿周围脑组织中TGF-β、IL-10的mRNA相对表达量比较差异无统计学意义(P>0.05)。结论急性脑出血患者血肿周围脑组织中促炎因子及M1型MG/MP水平升高,且M1型MG/MP的极化水平与脑出血后血肿周围水肿程度具有一致性。

Objective To explore the correlation between polarization status of microglia/macrophages(MG/MP)in brain tissue and edema around hematoma in patients with acute cerebral hemorrhage.Methods A total of 52 patients with acute intracerebral hemorrhage admitted to Anyang People′s Hospital from December 2020 to November 2022 were selected as the research subjects.All patients underwent craniotomy to remove hematoma,and the normal brain tissue in the cortical area that was not invaded by the hematoma and the fragmented brain tissue around the hematoma(brain tissue around the hematoma)on the surgical pathway were obtained.The expression levels of inflammatory factors such as interleukin(IL)-1β,IL-6,tumor necrosis factor-α(TNF-α),IL-10 and transforming growth factor-β(TGF-β)protein in brain tissue were detected by Western blot.The expression levels of IL-1β,IL-6,TNF-α,IL-10 and TGF-βmRNA in brain tissue were detected by fluorescence quantitative polymerase chain reaction.The levels of M1-type and M2-type MG/MP in brain tissue was detected by immunofluorescence confocal technique.CT images data of patients before operation were collected and the relative-erihematomal edema(r-PHE)was calculated.The patients were divided into high r-PHE group(2.0≤r-PHE<2.5)and low r-PHE group(1.5<r-PHE<2.0)according to r-PHE.The relative expression of IL-1β,IL-6,TNF-α,IL-10 and TGF-βmRNA in brain tissue around the hematoma of patients between the high r-PHE group and the low r-PHE group was compared.Results The relative expressions of IL-1β,IL-6,TNF-αprotein and mRNA in brain tissue around the hematoma were significantly higher than those in the normal brain tissues(P<0.05),but there was no significant difference in the relative expressions of IL-10 and TGF-βprotein and mRNA between the brain tissue around the hematoma and the normal brain tissue(P>0.05).The levels of M1 type and M2 type MG/MP in the brain tissue around the hematoma were significantly higher than those in normal brain tissue(P<0.05).The relative expressions of IL-1β,IL-6 and TNF-αmRNA in the brain tissue around the hematoma of patients in the high r-PHE group were significantly higher than those in the low r-PHE group(P<0.05),and there was no significant difference in the relative expressions of TGF-βand IL-10 mRNA in the brain tissue around the hematoma of patients between the two groups(P>0.05).Conclusion The levels of pro-inflammatory factors and M1-type MG/MP are increased in the brain tissue around the hematoma in patients with acute cerebral hemorrhage,and the degree of polarization of M1-type MG/MP is consistent with the degree of edema around hematoma after cerebral hemorrhage.