engleski

IL-1B AND TGF B CONCENTRATION IN CEREBROSPINAL FLUID IN PATIENTS WITH PRIMARY INTRAVENTRICULAR HEMORRHAGE (IVH) TREATED WITH CLOT LYSIS WITH LOW-DOSE TISSUE PLASMINOGEN ACTIVATOR (TPA)

Introduction: Inflammation is a key player in brain damage and increased production of pro-inflammatory and lower levels of the anti-inflammatory cytokines in periphery blood and cerebrospinal fluid (CBS) are associated with poorer clinical outcome after primary intraventricular hemorrhage (IVH). Objectives: The aim of this study was to investigate changes in concentration of interleukin (IL)-1β and Transforming Growth Factor β (TGF β) in CBS of patients with IVH and external ventricular drainage treated with catheter-based clot lysis with low-dose tissue plasminogen activator (tPA). Methods: Thirty adult patients with IVH were enrolled in the prospective study. The patients were divided in two groups: group A were treated with 3x1 mg/12 h tPA (15 pts ; age 69 (60-74) ; male 7) and control group B with placebo (15 pts ; age 62 (59-68) ; male 8). Intracerebral hemorrhage score on admission was equal in both group (ICH = 3 (2-3)). Concentration of IL-1 β and TGF β in CBF were determined 24 hours (day 1), 3 and 7 days after the start of clot lysis. Results: In the patients from group A the concentrations of IL- 1β were significantly lower on day 3 (19, 5 (11, 5-28, 5) vs. 39, 7 (16, 8-50, 5) ; p = 0, 022) and on day 7 (9 (0, 2-13, 3) vs. 50 (22, 6-65) ; p < 0, 001) and not significantly lower on day 1 (26 (12, 3-38, 2) vs. 37, 8 (15, 4-59, 3) ; p = 0, 15)(graph 1.), while the concentrations of TGF β were significantly higher on day 1 (2781 (1987, 7-3611 vs. 1982, 7 (1777, 4-1985) ; p = 0, 009) and day 3 (2179 (1889-2249, 3) vs. 1679 (1652, 8-1777, 4) ; p = 0, 002) and not significantly higher on day 7 (2321 (1787, 7- 2057, 3) vs. 2057, 3 (1756, 8-1862) ; p = 0, 51) (graph 2.). Conclusion: Intraventricular clot lysis with low-dose tPA probably amplify initially anti-inflammatory response and diminish inflammatory response at a later stage.

intraventricular hemorrhage; cerebrospinal fluid; tissue plasminogen activator

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