关键词: 自发性脑出血, 脑脊液, 炎症, 病情, 预后

Abstract:

Objective To examine the expression levels of inflammatory factors， including IL-6， IL-10， MMP-9， IL-17A， and LDH， in the cerebrospinal fluid （CSF） of patients with spontaneous intracerebral hemorrhage （sICH）， and to investigate their associations with disease severity and clinical outcomes. Methods A total of 168 patients with sICH admitted to Tangshan GongRen Hospital between January 2023 and January 2025 were prospectively enrolled as the study group， while 30 non-sICH patients who underwent lumbar puncture during the same period served as the control group. Levels of inflammatory factors in CSF were compared between the two groups. Spearman′s rank correlation analysis was performed to assess the association between inflammatory factor levels and clinical severity in sICH patients. Binary logistic regression analysis was conducted to identify independent predictors of sICH prognosis. Receiver operating characteristic （ROC） curve analysis was employed to evaluate the prognostic value of these inflammatory factors in sICH. Results The levels of IL-6， IL-10， MMP-9， IL-17A， and LDH in the CSF of patients with sICH were significantly higher than those in non-sICH patients （all P < 0.05）. Furthermore， among sICH patients， these biomarker levels exhibited a graded increase according to disease severity： severe > moderate > mild （all P < 0.05）. Spearman correlation analysis revealed significant positive correlations between CSF levels of IL-6， IL-10， MMP-9， IL-17A， and LDH and the NIHSS scores， with correlation coefficients （r） of 0.686， 0.553， 0.685， 0.593， and 0.695， respectively （all P < 0.05）. When comparing the prognoses of sICH patients， hematoma size， NIHSS score， and CSF levels of IL-6， IL-10， MMP-9， IL-17A， and LDH were significantly higher in the deceased group than in the survival group （P < 0.05）， whereas ApoA1 levels were lower in the deceased group （P < 0.05）. Logistic regression analysis revealed that hematoma size， NIHSS score， and elevated CSF levels of IL-6， IL-10， MMP-9， IL-17A， and LDH were independent risk factors for mortality in sICH patients （P < 0.05）. ROC curve analysis showed that the AUC values for CSF IL-6， IL-10， MMP-9， IL-17A， and LDH in predicting sICH prognosis were 0.794， 0.754， 0.670， 0.717， and 0.683， respectively. Notably， the combination of CSF inflammatory markers with hematoma size and NIHSS score yielded an AUC of 0.993， demonstrating significantly greater predictive accuracy than CSF inflammatory markers alone （P < 0.05）. Conclusions The levels of inflammatory factors in the CSF， including IL-6， IL-10， MMP-9， IL-17A， and LDH， were elevated in patients with sICH and positively correlated with disease severity. Combining CSF inflammatory markers with the NIHSS score and hematoma size improved the predictive accuracy for sICH prognosis.

Key words: spontaneous intracerebral hemorrhage, cerebrospinal fluid, inflammation, condition, prognosis