CAJ | 학술논문

目的探讨动脉瘤性蛛网膜下腔出血(aSAH)患者外周血单核细胞表面Toll样受体4(TLR4)表达水平与脑血管痉挛(CVS)的关系.方法 30例2013年10月至2014年10月在本院住院治疗的aSAH患者,以及年龄、性别与30例aSAH患者相匹配的20例正常人对照.在开始研究时采集20例对照的外周血;采集aSAH患者入院第1、3、7天的外周血;密度梯度离心法分离外周血单核细胞(PBMCs),流式细胞仪检测CD14/TLR4双阳性PBMCs细胞表面TLR4表达的平均荧光强度(MFI).aSAH患者入院1周内每天进行经颅多普勒超声检查,1周后隔天进行经颅多普勒超声检查,监控CVS的发生.结果 aSAH患者入院后第1、3天TLR4水平显著高于对照组;入院第1天TLR4水平最高,显著高于第3、7天;此后逐渐下降,入院后第7天与对照组之间差异无统计学意义(P＞0.05).入院时Hunt-Hess分级Ⅳ～V级的患者TLR4水平显著高于Ⅰ～Ⅲ级的患者;发生CVS的aSAH患者TLR4表达水平显著高于未发生者;并发由CVS导致脑缺血的aSAH患者入院第1天的TLR4水平显著高于未发生脑缺血的患者.逻辑回归分析显示入院第1天TLR4水平是预测CVS[比值比(OR):1.041;95％可信区间(CI):0.762 ～1.876;P ＜0.01]和迟发型脑缺血(DCI)(OR:4.78,95％ CI:2.44～ 12.71;P＜0.05)发生的独立因子.结论 aSAH患者TLR4在外周血单核细胞表面表达水平显著升高,与aSAH患者并发CVS和DCI密切相关.
목적 탐토동맥류성주망막하강출혈(aSAH)환자외주혈단핵세포표면Toll양수체4(TLR4)표체수평여뇌혈관경련(CVS)적관계.방법 30례2013년10월지2014년10월재본원주원치료적aSAH환자,이급년령、성별여30례aSAH환자상필배적20례정상인대조.재개시연구시채집20례대조적외주혈;채집aSAH환자입원제1、3、7천적외주혈;밀도제도리심법분리외주혈단핵세포(PBMCs),류식세포의검측CD14/TLR4쌍양성PBMCs세포표면TLR4표체적평균형광강도(MFI).aSAH환자입원1주내매천진행경로다보륵초성검사,1주후격천진행경로다보륵초성검사,감공CVS적발생.결과 aSAH환자입원후제1、3천TLR4수평현저고우대조조;입원제1천TLR4수평최고,현저고우제3、7천;차후축점하강,입원후제7천여대조조지간차이무통계학의의(P＞0.05).입원시Hunt-Hess분급Ⅳ～V급적환자TLR4수평현저고우Ⅰ～Ⅲ급적환자;발생CVS적aSAH환자TLR4표체수평현저고우미발생자;병발유CVS도치뇌결혈적aSAH환자입원제1천적TLR4수평현저고우미발생뇌결혈적환자.라집회귀분석현시입원제1천TLR4수평시예측CVS[비치비(OR):1.041;95％가신구간(CI):0.762 ～1.876;P ＜0.01]화지발형뇌결혈(DCI)(OR:4.78,95％ CI:2.44～ 12.71;P＜0.05)발생적독립인자.결론 aSAH환자TLR4재외주혈단핵세포표면표체수평현저승고,여aSAH환자병발CVS화DCI밀절상관.
Objective To investigate the relationship between Toll-like receptor 4 (TLR4) on peripheral blood mononuclear cells (PBMCs) and cerebral vasospasm (CVS) in patients with aneurysmal subarachnoid hemorrhage (aSAH).Methods 30 patients with aSAH hospitalized from October 2013 and October 2014 were enrolled in this prospective study.Control included 20 age-and sex-matched healthy adults.Blood samples were collected on day 1,3 and 7 after admission.TLR4 expression level on cell surface of CD14/TLR4 double positive peripheral blood mononuclear cells (PBMCs) was determined by flow cytometry and presented as mean fluorescence intensity (MFI).Within the first week after admission,patients were daily assessed by transcrauial Doppler sonography (TCD) to monitor the occurrence of CVS.Results aSAH patients showed a significantly higher TLR4 levels on day1 and 3 post aSAH compared to HC;TLR4 levels in aSAH patients on day 1 was highest compared with that on day 3,7 and in HC.TLR4 of aSAH patients on day 7 declined to the level showing no significant difference with that of HC.In patients with Hunt-Hess grade Ⅰ-Ⅲ lower TLR4 levels were observed.Patients with Doppler sonographic cerebral vasospasm (dCVS) presented significantly higher TLR4 levels than those without dCVS.In patients developing cerebral ischemia attributable to vasospasm higher TLR4 levels have already been observed on day 1 after ictus.Higher TLR4 levels were also statistically significantly associated with poor functional outcome after 3 months.Logistic regression analysis showed that TLR4 level on day 1 was independent predictor for CVS [odds ratio (OR):1.041;95％ confidence interval (CI):0.762-1.876;P ＜ 0.01] and delayed cerebral ischemia (DCI,OR:4.78,95 ％ CI:2.44-12.71;P ＜ 0.05) of aneurysmal aSAH patients.Conclusion Admission TLR4 level on PBMCs (day 1) is significantly increased in aneurysmal aSAH patient and statistically significantly correlates with the occurrence of CVS and DCI.