脑梗死患者血中IL-6、IL-8及TNF-α水平与血液凝固状态的相关性分析
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摘要
目的:探讨急性脑梗死患者血中白细胞介素6(IL-6)、IL-8及肿瘤坏死因子-α(TNF-α)的变化与血液凝固状态之间的关系。方法:急性脑梗死患者74例,根据美国国立卫生研究院卒中量表(NIHSS)评分不同分为轻度卒中组41例和中重度卒中组33例,纳入同期住院的非脑梗死患者30例为对照组。检测血清中IL-6、IL-8和TNF-α,血栓弹力图(TEG)检测凝血状态。分析细胞因子与凝血状态之间的关系。结果:脑梗死组患者血中反应血凝块硬度的G值明显高于对照组(P<0.05),中重度脑卒中组反应血凝块硬度的G和MA值水平均较对照组增高(P<0.05);脑梗死组IL-6和TNF-α高于对照组(P<0.05),中重度卒中组IL-6和TNF-α明显高于对照组(P<0.05);中重度组IL-8明显高于轻度卒中组(P<0.05);脑卒中患者血中TNF-α的变化与TEG中的G值呈正相关(r=0.295,P=0.015)。结论:IL-6及TNF-α参与了脑梗死血液高凝状态的形成;IL-8与病情严重程度相关;TNF-α与血凝块的硬度相关,可能是促进脑梗死患者血栓形成的重要因素。
Objective: To investigate the relationship between coagulation and the changes in levels of lnterleukin-6(IL-6), IL-8, and tumor necrosis factor-α(TNF-α) in patients with acute cerebral infarction.Methods: We recruited 74 patients with acute cerebral infarction. Patients were divided into the mild stroke group(n=41) and moderate-to-severe stroke group(n=33) according to severity of symptoms based on the National Institute of Health stroke scale(NIHSS) score. In addition, 30 patients without cerebral infarction and hospitalized during the same time as the cerebral infarction group were recruited as the control group.Coagulation was evaluated by thromboelastography, and serum levels of IL-6, IL-8, and TNF-α were detected by chemiluminescence analysis. We studied changes in cytokines between the groups and analyzed their relationship with coagulation. Results: The G-value reflecting clot hardness was higher in the cerebral infarction group than in the control group(P<0.05), and the increase in G-value and MA was greater in the moderate-to-severe stroke group compared to the control group(P<0.05). Compared to the IL-6 and TNF-α levels of the control group,those of the cerebral infarction group were higher(P<0.05) and those of the moderate-to-severe stroke group were significantly higher(P<0.05). IL-8 level in the moderate-to-severe stroke group was higher than that in the mild stroke group(P<0.05). Changes in serum TNF-α levels in cerebral infarction patients showed a positive correlation to G-value in TEG(r=0.295, P=0.015). Conclusion: IL-6 and TNF-α are involved in the coagulation of blood in patients with cerebral infarction. IL-8 is related to the severity of disease. TNF-α is related to the hardness of the clot which may be an important factor in promoting thrombosis in patients with cerebral infarction.
Objective: To investigate the relationship between coagulation and the changes in levels of lnterleukin-6(IL-6), IL-8, and tumor necrosis factor-α(TNF-α) in patients with acute cerebral infarction.Methods: We recruited 74 patients with acute cerebral infarction. Patients were divided into the mild stroke group(n=41) and moderate-to-severe stroke group(n=33) according to severity of symptoms based on the National Institute of Health stroke scale(NIHSS) score. In addition, 30 patients without cerebral infarction and hospitalized during the same time as the cerebral infarction group were recruited as the control group.Coagulation was evaluated by thromboelastography, and serum levels of IL-6, IL-8, and TNF-α were detected by chemiluminescence analysis. We studied changes in cytokines between the groups and analyzed their relationship with coagulation. Results: The G-value reflecting clot hardness was higher in the cerebral infarction group than in the control group(P<0.05), and the increase in G-value and MA was greater in the moderate-to-severe stroke group compared to the control group(P<0.05). Compared to the IL-6 and TNF-α levels of the control group,those of the cerebral infarction group were higher(P<0.05) and those of the moderate-to-severe stroke group were significantly higher(P<0.05). IL-8 level in the moderate-to-severe stroke group was higher than that in the mild stroke group(P<0.05). Changes in serum TNF-α levels in cerebral infarction patients showed a positive correlation to G-value in TEG(r=0.295, P=0.015). Conclusion: IL-6 and TNF-α are involved in the coagulation of blood in patients with cerebral infarction. IL-8 is related to the severity of disease. TNF-α is related to the hardness of the clot which may be an important factor in promoting thrombosis in patients with cerebral infarction.
引文
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[13]Shishkova VN,Adasheva TV,Remenik AY,et al.Prognostic significance of clinical-anthropometric,biochemical,metabolic,vascular-inflammatory and molecular-genetic markers in the development of the first ischemic stroke[J].Zh Nevrol Psikhiatr Im S S Korsakova,2018,118:4-11.
[2]Bester J,Pretorius E.Effects of IL-1β,IL-6 and IL-8 on erythrocytes,platelets and clot viscoelasticity[J].Sci Rep,2016,6:32188.
[3]Elliott A,Wetzel J,Roper T,et al.Thromboelastography in patients with acute ischemic stroke[J].Int J Stroke,2015,10:194-201.
[4]Pretorius E,du Plooy JN,Bester J.A Comprehensive Review on Eryptosis[J].Cell Physiol Biochem,2016,39:1977-2000.
[5]Levi M,Poll TV.Coagulation in patients with severe sepsis[J].Semin Thromb Hemost,2015,41:9-15.
[6]Esmon CT.The interactions between inflammation and coagulation[J].Br J Haematol,2005,131:417-430.
[7]Bissinger R,Artunc F,Qadri S,et al.Reduced Erythrocyte Survival in Uremic Patients Under Hemodialysis or Peritoneal Dialysis[J].Kidney Blood Press Res,2016,41:966-977.
[8]Levi M,van der Poll T:Two-way interactions between inflammation and coagulation[J].Trends Cardiovasc Med,2005,15:254-259.
[9]Sun H,Zou X,Liu L.Epidemiological factors of stroke:a survey of the current status in china[J].J Stroke,2013,15:109-114.
[10]Rosamond W,Flegal K,Furie K,et al:Heart disease and stroke statistics--2008 update:a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee[J].Circulation,2008,117:e25-146.
[11]Bester J,Matshailwe C,Pretorius E.Simultaneous presence of hypercoagulation and increased clot lysis time due to IL-1β,IL-6 and IL-8[J].Cytokine,2018,110:237-242.
[12]Campbell RA,Vieira-de-Abreu A,Rowley JW,et al.Clots Are Potent Triggers of Inflammatory Cell Gene Expression:Indications for Timely Fibrinolysis[J].Arterioscler Thromb Vasc Biol,2017,37:1819-1827.
[13]Shishkova VN,Adasheva TV,Remenik AY,et al.Prognostic significance of clinical-anthropometric,biochemical,metabolic,vascular-inflammatory and molecular-genetic markers in the development of the first ischemic stroke[J].Zh Nevrol Psikhiatr Im S S Korsakova,2018,118:4-11.