Petzold A, Keir G, Kay A, Kerr M, Thompson E J
Department of Neuroimmunology, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
J Neurol Neurosurg Psychiatry. 2006 Jun;77(6):753-9. doi: 10.1136/jnnp.2005.085175.
On the basis of preliminary evidence from patients with subarachnoid haemorrhage (SAH), axonal degeneration is thought to be an underestimated pathological feature.
A longitudinal study in 17 patients with aneurysmal SAH. Ventricular CSF was collected daily for up to 14 days. The neurofilament heavy chain(SMI35) (NfH(SMI35), a biomarker for axonal damage) was quantified using a standard ELISA (upper limit of normal 0.73 ng/ml). The primary outcome measure was the Glasgow Outcome Score (GOS) at 3 months.
Of 148 samples from patients with SAH, pathologically high NfH levels in the CSF were found in 78 (52.7%) samples, compared with 20 (5%) of 416 samples from the reference population (p<0.0001). A pathological increase in NfH was observed in all patients with a bad outcome (GOS 1-3) compared with 8% of those with a good outcome (GOS 4-5, p<0.0001). This increase typically became significant 7 days after the haemorrhage (p<0.01). The result was confirmed by analysing the individual mean NfH concentrations in the CSF (3.45 v 0.37 ng/ml, p<0.01), and was reinforced by the inverse correlation of NfH in the CSF with the GOS (r = -0.65, p<0.01). Severity of injury was found to be correlated to NfH(SMI35) levels in the CSF (World Federation of Neurological Surgeons, r = 0.63, p<0.01 and Glasgow Coma Score, r = -0.61, p<0.01).
Patients with SAH thus have secondary axonal degeneration, which may adversely affect their outcome.
基于蛛网膜下腔出血（SAH）患者的初步证据，轴突退变被认为是一种被低估的病理特征。
对17例动脉瘤性SAH患者进行纵向研究。每天收集脑室脑脊液，最长收集14天。使用标准酶联免疫吸附测定法（ELISA）对轴突损伤生物标志物神经丝重链（SMI35）（NfH(SMI35)）进行定量（正常上限为0.73 ng/ml）。主要结局指标是3个月时的格拉斯哥预后评分（GOS）。
在SAH患者的148份样本中，78份（52.7%）脑脊液中NfH水平在病理上较高，而在参考人群的416份样本中，有20份（5%）如此（p<0.0001）。与预后良好（GOS 4 - 5）的患者中8%相比，所有预后不良（GOS 1 - 3）的患者均观察到NfH病理性升高（p<0.0001）。这种升高通常在出血后7天变得显著（p<0.01）。通过分析脑脊液中个体平均NfH浓度（3.45对0.37 ng/ml，p<0.01）证实了该结果，并且脑脊液中NfH与GOS的负相关（r = -0.65，p<0.01）进一步强化了该结果。发现损伤严重程度与脑脊液中NfH(SMI35)水平相关（世界神经外科医师联合会，r = 0.63，p<0.01；格拉斯哥昏迷评分，r = -0.61，p<0.01）。
因此，SAH患者存在继发性轴突退变，这可能对其预后产生不利影响。
