Análise de citocinas no acidente vascular cerebral

Abstract

Cytokines has studied as inflammatory biomarkers and can be involved from pathogenesis to neurotoxicity in stroke. Therefore, several studies have been conducted to inhibit or stimulate the production of these biomarkers after a stroke, with the objective of improving the progression of the consequences of the disease. The physical exercises alter circulating cytokines, and can assist in this recovery process in the post-stroke period. Our objective was perform a systematic review and meta-analysis of the physical exercise effects on cytokines after stroke, and then analyze the levels of circulating cytokines and to verify the correlation with the severity of the disease and muscle strength. For the systematic review, seven databases were used in search of articles with the Patient-Intervention-Comparison- Outcomes-Study (PICOS) strategy. To assess the risk of bias, we used the criteria described in the Cochrane Handbook for Systematic Review of Interventions and the Physiotherapy Evidence Database scale and subsequently a meta-analysis of the studies with homogeneous outcomes was performed. In patients with acute stroke, cytokine levels were assessed using the Enzyme-linked immunosorbent assay (ELISA) and Cytometric bead array (CBA) method. These levels were compared between patients and controls and correlated with manual muscle strength and disease severity assessed by NIHSS. In the review, we obtained 14489 articles in the databases, of which only 5 were included according to criteria. Five selected articles, all analyzed the IL6. Two randomized trials analyzed serum levels of TNF-α. The qualitative analysis of these studies showed differences in methodologies and results. Three studies were classified for metaanalysis. None of the three randomized trials correlated cytokine levels with any clinical or functional outcome, but there may be a reduction in IL-6 and TNF- levels when analyzed in an associated way. In the experimental study, 17 patients with stroke in the acute phase were evaluated. A reduction in serum TNF- levels and an increase in IL-6 and IL-10 were observed in the stroke group compared to the control group. We observed a greater tendency in the patients' anti-inflammatory response. In addition, patients had a low positive correlation between serum IL-6 and IL-10 levels. An association was found between IL12p70 with NIHSS and hand grip strength on the affected side; IL-1β with handgrip strength on the affected side; IL-6 with handgrip strength on the unaffected side. Therefore, we conclude that the review and meta-analysis showed that despite the signs of reduced IL-6 and TNF- associated with exercise, the number of studies related to the topic is still reduced. The comparison between patients and controls showed a correlation between some cytokines and the severity scale and handgrip strength.