Effect of mild hypothermia on expression of inflammatory factors in surrounding tissue after minimally invasive hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage

Abstract

Mild hypothermia combined with minimally invasive hematoma evacuation was evaluated in the treatment of hypertensive intracerebral hemorrhage to reduce inflammatory response of brain tissue around hematoma and ameliorate brain function, and to investigate its safety, effectiveness and feasibility. A total of 206 patients with acute spontaneous hypertensive intracerebral hemorrhage were collected clinically and randomly divided into minimally invasive hematoma evacuation group (group A) and mild hypothermia combined with minimally invasive hematoma evacuation (group B). The National Institutes of Health Stroke Scale (NIHSS) score was used before and after treatment. Group A was treated with minimally invasive intracranial hematoma evacuation using intracranial hematoma grinding puncture needle while group B received whole body water circulation type cooling blanket plus local cerebral mild hypothermia therapy with ice cap on the basis of minimally invasive surgery. Patients brain tissue fragments around hematoma taken out with rinsing during operation and at postoperative 1, 3 and 7 days were investigated. The contents of tumor necrosis factor-α (TNF-α) in serum at postoperative 1, 3 and 7 days were evaluated by enzyme-linked immunosorbent assay (ELISA). For the degree of nerve function defect of patients in the two groups, NIHSS score was lower in group B than that in group A at days 3 and 7, and the differences were statistically significant (P<0.05). The serum TNF-α content and expression of nuclear factor-κB (NF-κB) in brain tissue around hematoma reached the peak on the 3rd day. The TNF-α content and NF-κB expression were lower in group B than those in group A at each time-point (P<0.05). Mild hypothermia combined with minimally invasive hematoma evacuation can reduce the damage of hematoma to the surrounding brain tissue, effectively alleviate inflammatory response and decrease brain tissue injury, thus ameliorating brain function.

Keywords: NF-κB; inflammatory response; intracerebral hemorrhage; mild hypothermia; minimally invasive hematoma evacuation.

Figure 1.

H&E staining of tissue around the hematoma. (A) Loose tissue around the hematoma, extensive extravascular space, the gap around the nerve cells and glial cells (magnification, ×200); (B) nerve cell body atrophy, karyopyknosis, Nissls body disappearance and eosinophilic change in cytoplasm; a large number of neutrophils and lymphocytes around the hematoma (magnification, ×100). H&E, hematoxylin and eosin.

Figure 2.

Detection of NF-κB expression in brain tissue around the hematoma using immunohistochemistry. (A) NF-κB expression at day 1 in group A (magnification, ×400); (B) NF-κB expression at day 1 in group B (magnification, ×200); (C) NF-κB expression at day 3 in group A (magnification, ×400); (D) NF-κB expression at day 3 in group B (magnification, ×400); (E) NF-κB expression at day 7 in group A (magnification, ×200); (F) NF-κB expression at day 7 in group B (magnification, ×200). NF-κB, nuclear factor-κB.