Changes of Cytokines in Yin-Yang Syndrome Classification in Hypertensive Cerebral Hemorrhage Patients
Objective To investigate the patterns of serum cytokine changes in patients with hypertensive intracerebral hemorrhage(ICH)and stroke-associated pneumonia(SAP).Methods A total of 60 ICH patients were enrolled and assigned to two groups based on Chinese medicine(CM)syndromes:the Yin syndrome group(19 cases,including 6 with SAP and 13 without SAP)and the yang syndrome group(41 cases,including 37 with SAP and 4 without SAP).Patient condition scores were compared.Serum concentrations of inflammatory cytokines at four time points post-ICH onset[0-3(T1),4-7(T2),8-14(T3),and 15-25 days(T4)]were measured using liquid chip technology and ELISA.Results Compared with the yin syndrome group,the yang syndrome group showed higher scores on the National Institutes of Health Stroke Scale(NIHSS),Pneumonia Severity Index(PSI),Intracranial Haemorrhage Score(ICH-S)at admission,and modified Rankin Scale(mRS)at discharge(P＜0.05,P＜0.01),and lower Glasgow Coma Scale(GCS)scores at admission(P＜0.01).Cytokines that showed statistically significant differences between the two groups at least one time point included interleukin(IL)-88,recombinant IL-1 receptor acntagonist(IL-1RA),macrophage inflammatory protein-1(MIP-1)β,IL-18,IL-5,interferon-inducible protein-10(IP-10),IL-7,IL-12p70,monocyte chemotactic protein 1(MCP-1),IL-1 α,IL-22,and stromal cell derived factor 1(SDF-1)α(P＜0.05).In the yang syndrome group,the concentrations of several pro-inflammatory cytokines,including MIP-1 α,MIP-1 β,IL-18,IL-17A,and IL-31,increased significantly at T1 and T2.Early increases were observed in some anti-inflammatory cytokines,including IL-10,IL-4,and IL-8.In contrast,these cytokines decreased at T1 in the yin syndrome group.The serum concentration of regulated on activation,normal T cell expressed and secreted(RANTES)increased at T1,decreased at T2,and ultimately fell below baseline levels at T4 in both groups,regardless of SAP presence.In ICH patients with SAP,cytokines showing statistically significant differences between the two groups at least one time point included IP-10,IL-1RA,MIP-1 β,and IL-18(P＜0.05).In the yang syndrome group of ICH patients with SAP,the concentrations of pro-inflammatory cytokines,including IP-10,MCP-1,IL-8,IL-17A,MIP-1 α,MIP-1 β,IL-31,interferon gamma(IFN-γ),IL-1 α,and IL-21,increased significantly at T1 and T2.Conclusion Serum cytokines in ICH patients exhibit dynamic changes under the classification of yin and yang syndromes,with pro-inflammatory responses being fundamental to the yang syndrome.
hypertensive intracerebral hemorrhagestroke-associated pneumoniaserum cytokinesyin and yang syndromesintegrative medicine
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