IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Department of Neuroscience, Via G. La Masa 19, 20156 Milan, Italy.
Br J Anaesth. 2013 Sep;111(3):424-32. doi: 10.1093/bja/aet149. Epub 2013 May 5.
Vasospasm and other secondary neurological insults may follow subarachnoid haemorrhage (SAH). Biomarkers have the potential to stratify patient risk and perhaps serve as an early warning sign of delayed ischaemic injury.
Serial cerebrospinal fluid (CSF) samples were collected from 38 consecutive patients with aneurysmal SAH admitted to the neurosurgical intensive care unit. We measured heart-fatty acid-binding protein (H-FABP) and tau protein (τ) levels in the CSF to evaluate their association with brain damage, and their potential as predictors of the long-term outcome. H-FABP and τ were analysed in relation to acute clinical status, assessed by the World Federation of Neurological Surgeons (WFNS) scale, radiological findings, clinical vasospasm, and 6-month outcome.
H-FABP and τ increased after SAH. H-FABP and τ were higher in patients in poor clinical status on admission (WFNS 4-5) compared with milder patients (WFNS 1-3). Elevated H-FABP and τ levels were also observed in patients with early cerebral ischaemia, defined as a CT scan hypodense lesion visible within the first 3 days after SAH. After the acute phase, H-FABP, and τ showed a delayed increase with the occurrence of clinical vasospasm. Finally, patients with the unfavourable outcome (death, vegetative state, or severe disability) had higher peak levels of both proteins compared with patients with good recovery or moderate disability.
H-FABP and τ show promise as biomarkers of brain injury after SAH. They may help to identify the occurrence of vasospasm and predict the long-term outcome.
蛛网膜下腔出血（SAH）后可能会出现血管痉挛和其他继发性神经损伤。生物标志物有可能对患者的风险进行分层，并且可能作为迟发性缺血性损伤的早期预警信号。
连续收集 38 例因颅内动脉瘤破裂而入住神经外科重症监护病房的患者的脑脊液（CSF）样本。我们测量了 CSF 中心脏脂肪酸结合蛋白（H-FABP）和 tau 蛋白（τ）的水平，以评估它们与脑损伤的关系，以及它们作为长期预后预测指标的潜力。分析了 H-FABP 和 τ 与急性临床状态、世界神经外科学会（WFNS）评分评估的影像学表现、临床血管痉挛以及 6 个月的预后的关系。
SAH 后 H-FABP 和 τ 升高。入院时临床状态较差（WFNS 4-5）的患者 H-FABP 和 τ 高于临床状态较轻的患者（WFNS 1-3）。在早期脑缺血患者中也观察到 H-FABP 和 τ 水平升高，早期脑缺血定义为 SAH 后 3 天内 CT 扫描可见的低密病灶。在急性期后，随着临床血管痉挛的发生，H-FABP 和 τ 表现出延迟性增加。最后，与恢复良好或中度残疾的患者相比，预后不良（死亡、植物状态或严重残疾）的患者的两种蛋白质峰值水平均较高。
H-FABP 和 τ 有望成为 SAH 后脑损伤的生物标志物。它们可能有助于识别血管痉挛的发生并预测长期预后。
