Department of Neurology, Rudolf Magnus Institute of Neuroscience, Utrecht, The Netherlands.
Cerebrovasc Dis. 2010;29(6):576-83. doi: 10.1159/000306645. Epub 2010 Apr 8.
A proinflammatory prothrombotic state may increase the risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH). We studied the relationship of levels of leukocytes, platelets, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) with the development of DCI and with clinical outcome in patients with aneurysmal SAH.
In 125 patients admitted within 72 h after aneurysmal SAH, we dichotomized initial blood levels at their median values and investigated the prediction of DCI with Cox proportional hazard analysis and of poor clinical outcome with logistic regression analysis. We also analyzed concentrations before and after onset of DCI with the paired-samples t test and compared changes with those in patients without DCI.
During the development of DCI (unrelated to treatment), patients had a larger increase in counts of platelets (difference 49 x 10(9)/l; 95% CI: 2-98) and leukocytes (difference 2.6 x 10(9)/l; 95% CI: 0.4-5.0) than patients without DCI during the same period. CRP increased during DCI and decreased in patients without DCI (difference 14 mg/l; 95% CI: -29 to 58). ESR increased slightly in both groups (difference 3 mm/h; 95% CI: -15 to 20). None of the determinants at baseline predicted the development of DCI. An increased risk of poor outcome predicted by a high initial leukocyte count (OR 2.5; 95% CI: 1.1-5.7) decreased after adjustment for clinical variables (OR 2.1; 95% CI: 0.8-5.5).
Counts of platelets and leukocytes disproportionally increase during the occurrence of DCI after aneurysmal SAH. Drugs with anti-thrombotic or anti-inflammatory properties should be studied for prevention and treatment of DCI.
促炎和促血栓形成状态可能会增加动脉瘤性蛛网膜下腔出血（SAH）后迟发性脑缺血（DCI）的风险。我们研究了白细胞、血小板、C 反应蛋白（CRP）和红细胞沉降率（ESR）水平与动脉瘤性 SAH 患者 DCI 发生的关系，以及与临床结局的关系。
我们对 125 例在动脉瘤性 SAH 后 72 小时内入院的患者进行了初始血液水平的中位数二分法，并使用 Cox 比例风险分析来预测 DCI，使用逻辑回归分析来预测临床结局不良。我们还使用配对样本 t 检验分析了 DCI 发生前后的浓度，并与无 DCI 的患者进行了比较。
在 DCI 的发展过程中（与治疗无关），与同期无 DCI 的患者相比，患者的血小板计数（差异 49×109/L；95%CI：2-98）和白细胞计数（差异 2.6×109/L；95%CI：0.4-5.0）增加更大。CRP 在 DCI 期间升高，而无 DCI 的患者则降低（差异 14mg/L；95%CI：-29 至 58）。ESR 在两组中均略有增加（差异 3mm/h；95%CI：-15 至 20）。基线时的任何指标都不能预测 DCI 的发生。高初始白细胞计数预测不良结局的风险增加（OR 2.5；95%CI：1.1-5.7），但经临床变量调整后降低（OR 2.1；95%CI：0.8-5.5）。
在动脉瘤性 SAH 后 DCI 的发生过程中，血小板和白细胞计数不成比例地增加。应该研究具有抗血栓和抗炎特性的药物，以预防和治疗 DCI。
