脑出血患者血肿周围炎症反应启动因素的初步研究

Starting Factors of Perihematoma Inflammatory Reaction in Intracerebral Hemorrhage

目的:探讨脑出血患者血肿周围炎症反应的启动因素。方法:对206例脑出血患者行微创血肿抽吸引流,取12例局部注入低分子肝素并吸出脑组织及脑组织液的患者作为干预组,另取12例未经肝素处理并吸出脑组织及脑组织液的患者作为普通组。2组术中脑组织行HE染色及免疫组化以分别进行炎症细胞计数和TNF-α阳性细胞计数,同时以ELISA检测2组术中和术后第4天引流液中IL-6、IL-10浓度。结果:干预组炎性细胞计数[(123.10±5.342)个/5视野]明显低于普通组[(174.00±7.281)个/5视野],差异有统计学意义(P<0.01)。2组TNF-α阳性细胞计数差异无统计学意义。干预组术后第4天IL-6、IL-10浓度均明显低于术中(P<0.01),而普通组无显著变化。结论:局部应用低分子肝素能抑制脑出血后血肿周围炎症细胞浸润,降低IL-6、IL-10的表达,推测凝血酶的激活可能是脑出血后炎症反应的启动环节之一。

Objective： To study initial factors of perihematoma inflammatory reaction in intracerebral hemorrhage （ICH）. Methods： 24 patients with ICH who have been treated by micro-invasive drainage and aspiration were divided into interventional group and ordinary treatment group （n= 12/group）. Low molecular heparin was infused into the hematoma through the aspirating catheters after aspiration in interventional group. Perihematoma cerebral tissues in both groups were harvested and prepared for Hematoxylin ＆ Eosin staining and immunohistochemistry before counting the inflammatory cells and TNF-α positive cells. Concentrations of IL-6 and IL-10 in the liquid drained 4 days after the operation were detected with enzyme-linked immunosorbent assay （ELISA）. Results： The number of inflammatory cells is （174.00± 7. 281） and （123.10± 5. 342） every 5-visual-field under the microscope in the ordinary and interventional groups respectively（P 〈0.01）. There was no significant differences in number of TNF-α positive cells and between two groups（P〉0. 05）. No remarkable changes of IL-6 and IL-10 concentrations was detected after operation in the ordinary group（P〉0. 05）, but significant differences in the levels of the factors above in the interventional group were observed（P〈0.01）. Conclusion： There are inflammatory reactions in the perihematoma areas in ICH. Administration of low molecular heparin to the areas may ameliorate the infiltration of inflammatory cells and to decrease the expression of inflammatory cytokines. The activation of thrombin may act as a initial factor for starting the inflammatory reaction in ICH.