C 反应蛋白作为预测动脉瘤性蛛网膜下腔出血不良预后的指标。

C-reactive protein as predictor for poor outcome after aneurysmal subarachnoid haemorrhage.

机构信息

Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland.

出版信息

Acta Neurochir (Wien). 2012 Mar;154(3):397-404. doi: 10.1007/s00701-011-1243-7. Epub 2011 Dec 3.

DOI:10.1007/s00701-011-1243-7

PMID:22134501

Abstract

BACKGROUND

Aneurysmal subarachnoid haemorrhage (SAH) is a severe disease with high case-fatality and morbidity rates. After SAH, the value of C-reactive protein (CRP)--an acute phase sensitive inflammatory marker--as a prognostic factor has been poorly studied, with conflicting results. In this prospective study, we tested whether increased CRP levels increase independently the risk for cerebral infarct and poor outcome.

METHODS

Previous diseases as well as clinical, laboratory and radiological variables were recorded for 178 patients with SAH admitted within 48 h and with aneurysms occluded within 60 h after bleeding. Plasma CRP was measured, as well as computed tomography (CT) scans routinely obtained on admission, in the morning after aneurysm occlusion, and at discharge during second week after SAH. Factors predicting occurrence of cerebral infarct and poor outcome at 3 months after SAH were tested with multiple logistic regression.

RESULTS

CRP levels increased significantly (p < 0.001) between hospital admission (mean ± SD, 11.4 ± 21.3 mg/l) and the postoperative morning (27.0 ± 31.0 mg/l) and then decreased (p < 0.001) during the the second week (19.8 ± 25.0 mg/l). Admission (18.0 ± 35.7 vs 8.5 ± 8.4 mg/l) and postoperative (41.0 ± 40.2 vs 21.1 ± 24.1 mg/l) CRP levels were higher (p < 0.001) in those with a poor outcome than in those with a favourable outcome, but CRP values did not predict delayed cerebral ischaemia or cerebral infarction. CRP levels did not independently predict outcome, since these correlated with admission clinical grade and occurrence of intraventricular haemorrhage. Higher increase in CRP level between admission and postoperative morning, however, independently predicted poor outcome (p = 0.004). Part of this increased risk was likely due to an appearance of early postoperative cerebral infarction.

CONCLUSIONS

CRP levels correlate with outcome but do not seem to predict delayed cerebral ischaemia or infarction after SAH.

摘要

背景

蛛网膜下腔出血（SAH）是一种严重的疾病，其病死率和发病率都很高。在 SAH 后，C 反应蛋白（CRP）——一种急性相敏感的炎症标志物——作为预后因素的价值研究得还不够充分，结果也存在矛盾。在这项前瞻性研究中，我们测试了 CRP 水平升高是否会独立增加脑梗死和不良结局的风险。

方法

我们记录了 178 例在出血后 48 小时内和在出血后 60 小时内闭塞动脉瘤的 SAH 患者的既往疾病以及临床、实验室和影像学变量。在入院时、动脉瘤闭塞后次日早晨和 SAH 后第二周的住院期间常规测量血浆 CRP，并进行计算机断层扫描（CT）检查。使用多因素逻辑回归测试预测 3 个月后发生脑梗死和不良结局的因素。

结果

CRP 水平在入院时（平均±标准差，11.4±21.3mg/L）和术后次日早晨（27.0±31.0mg/L）之间显著升高（p<0.001），然后在第二周（19.8±25.0mg/L）期间下降（p<0.001）。入院时（18.0±35.7 vs 8.5±8.4mg/L）和术后（41.0±40.2 vs 21.1±24.1mg/L）的 CRP 水平在预后不良的患者中较高（p<0.001），但 CRP 值并不能预测迟发性脑缺血或脑梗死。CRP 水平并不能独立预测结局，因为它们与入院时的临床分级和发生的脑室内出血有关。然而，入院和术后次日早晨之间 CRP 水平升高幅度较大，可独立预测不良结局（p=0.004）。这种增加的风险部分可能是由于术后早期出现脑梗死。