Neurological Institute of New York, 177 Fort Washington Avenue, New York, NY 10032, USA.
Stroke. 2012 Mar;43(3):691-6. doi: 10.1161/STROKEAHA.111.636035. Epub 2012 Jan 26.
The purpose of this study was to understand factors related to increases in serum free fatty acid (FFA) levels and association with delayed cerebral ischemia (DCI) after subarachnoid hemorrhage.
We performed serial measurement of systemic oxygen consumption by indirect calorimetry and FFA levels by liquid chromatography/mass spectrometry in the first 14 days after ictus in 50 consecutive patients with subarachnoid hemorrhage. Multivariable generalized estimating equation models identified associations with FFA levels in the first 14 days after SAH and Cox proportional hazards model used to identified associations with time to DCI.
There were 187 measurements in 50 patients with subarachnoid hemorrhage (mean age, 56±14 years old; 66% women) with a median Hunt-Hess score of 3. Adjusting for Hunt-Hess grade and daily caloric intake, n-6 and n-3 FFA levels were both associated with oxygen consumption and the modified Fisher score. Fourteen (28%) patients developed DCI on median postbleed Day 7. The modified Fisher score (P=0.01), mean n-6:n-3 FFA ratio (P=0.02), and mean oxygen consumption level (P=0.04) were higher in patients who developed DCI. In a Cox proportional hazards model, the mean n-6:n-3 FFA ratio (P<0.001), younger age (P=0.05), and modified Fisher scale (P=0.004) were associated with time to DCI.
Injury severity and oxygen consumption hypermetabolism are associated with higher n-FFA levels and an increased n-6:n-3 FFA ratio is associated with DCI. This may indicate a role for interventions that modulate both oxygen consumption and FFA levels to reduce the occurrence of DCI.
本研究旨在了解与蛛网膜下腔出血（SAH）后血清游离脂肪酸（FFA）水平升高相关的因素及其与迟发性脑缺血（DCI）的关系。
我们对 50 例连续的 SAH 患者在发病后的前 14 天内通过间接热量法连续测量全身氧耗量，通过液相色谱/质谱法测量 FFA 水平。多变量广义估计方程模型确定了在 SAH 后前 14 天内 FFA 水平的相关性，Cox 比例风险模型确定了与 DCI 发生时间的相关性。
在 50 例 SAH 患者中进行了 187 次测量（平均年龄 56±14 岁，66%为女性），中位 Hunt-Hess 评分为 3 分。调整 Hunt-Hess 分级和每日热量摄入后，n-6 和 n-3 FFA 水平均与氧耗量和改良 Fisher 评分相关。中位数为出血后第 7 天，14 例（28%）患者发生 DCI。发生 DCI 的患者改良 Fisher 评分（P=0.01）、平均 n-6:n-3 FFA 比值（P=0.02）和平均氧耗量（P=0.04）均较高。在 Cox 比例风险模型中，平均 n-6:n-3 FFA 比值（P<0.001）、年龄较小（P=0.05）和改良 Fisher 评分（P=0.004）与发生 DCI 的时间相关。
损伤严重程度和氧耗量代谢亢进与较高的 n-FFA 水平相关，n-6:n-3 FFA 比值升高与 DCI 相关。这可能表明，调节氧耗量和 FFA 水平的干预措施可能降低 DCI 的发生。
