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ECPB 2013, 62(2): 62–68
Clinical physiology and biochemistry

Humoral proinflammatory factors and stress-release system activity after hemorrhagic stroke caused by arterial aneurysm rupture

SHEVAGA V., NETLYUKH A., BILOBRYN M., MATOLINETS N., KUNINA I.
Abstract

The research purpose was to set the dynamics of level of citokines and glucocortikoids as markers of inflammatory and stress reaction at hemorragic stroke, the diagnostic and prognostic value.

Methods. 27 patients with hemorragic stroke caused by a rupture of arterial aneurysms of different localization have been examined. 11 patients were selected with unfavourable course of disease, when the secondary cerebral ischemia or death of patient appeared as a result of ischemic complications of subarachnoid hemorrhage. The determination of metabolits of glucocorticoids – 17-ketogenous steroids (17-KGS) and level of interleukine-6 (IL-6) was conducted in the blood serum of patients on 1st–3rd, 7th and 14th days of acute period.

Results of research and discussion. The content of 17-KGS in relation to the control was for certain enhanceable (control – 50,8±3,6 mkmole/l, p<0,001) in all probed terms after hemorragic stroke. The level of IL-6 on 1st–3rd days of disease was 5,2±1,7 pg/ml, being unreliable (p=0,1) enhanceable in comparison to the control (1,9±0,1 pg/ml). On the 7th day the level of IL-6 made 7,6±1,8 pg/ml and was reliably (p<0,01) elevated in comparison to the control. On the 14th day there was a decline of level of IL-6 almost twice in comparison to the 7th day down to 4,0±0,6 pg/ml. The patients of group with favourable outcome on the 1st–3rd days had a level of 17-KGS reliably (p<0,001) lower, than in patients with unfavourable course. On the 7th day of disease (in comparison to the 1st–3rd days) a reliable decline of 17-KGS level was observed in the first group of probed (p<0,05), while the patients of the second group showed its’ substantial increase (p<0,001). On the 1st–3rd days at favourable course of hemorragic stroke the level of IL-6 was certainly (p<0,05) higher and made 10,6±2,2 pg/ml, while at unfavourable outcome this index consisted of 3,8±0,5 pg/ml. Favourable course on the 7th days was accompanied by the reliable (p<0,05) decline of IL-6 level comparing to the 1st–3rd day, and unfavourable, on the contrary, reliable (p<0,05) by three-fold growth of IL-6 in this term.

Conclusions. There have been noted high concentrations of metabolits of glukocorticoids and IL-6at hemorragic stroke. Reliable decline of 17-KGS level and IL-6 on 7th day after a hemorragic stroke in comparison to the period of 1–3rd days can serve as the additional criterion of prognosis of vasospasm appearance and delayed ischemic brain damage. Elevation of IL-6 level has different action with prevalence of anti-inflammatory effect on the 1st–3rd days, and mostly pro-inflammatory effect – on the 7th days after hemorragic stroke.

Keywords: hemorrhagic stroke, arterial aneurysm, stress reaction, cytokines, glucocorticoids, immunoneuroendocryne system

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