Cai Jian-Yong, Chen Xian-Dong, Ba Hua-Jun, Lin Jian-Hu, Lu Chuan, Chen Mao-Hua, Sun Jun
Department of Neurosurgery, The Central Hospital of Wenzhou City, 32 Dajian Lane, Wenzhou 325000, China.
Department of Neurosurgery, The Central Hospital of Wenzhou City, 32 Dajian Lane, Wenzhou 325000, China.
Peptides. 2014 Sep;59:9-13. doi: 10.1016/j.peptides.2014.06.014. Epub 2014 Jul 5.
Increased plasma adrenomedullin levels have been reported in critically ill patients. This study tested the hypothesis that plasma adrenomedullin levels are significantly increased in patients with acute spontaneous aneurysmal subarachnoid hemorrhage, and are predictive of clinical outcomes. Plasma adrenomedullin levels from 120 adult patients with spontaneous aneurysmal subarachnoid hemorrhage and 120 healthy volunteers during the study period were evaluated. Mortality and poor long-term outcome (Glasgow Outcome Scale score of 1-3) at 6 months were recorded. Data showed that circulating plasma adrenomedullin levels significantly increased in patients on admission compared with the volunteers. In patients who died or had poor outcome at 6 months, plasma adrenomedullin levels were significantly higher compared with survivors and patients with good outcome. Plasma adrenomedullin levels on presentation were highly associated with clinical severity assessed using World Federation of Neurological Surgeons score and Fisher score, emerged as the independent risk factor of 6-month mortality and poor outcome, and possessed similar predictive value to World Federation of Neurological Surgeons score and Fisher score based on receiver operating characteristic curves. A combined logistic-regression model did not demonstrate the additive benefit of adrenomedullin to World Federation of Neurological Surgeons score and Fisher score. Thus, higher plasma adrenomedullin levels on presentation are associated with clinical severity and worse outcomes in patients with acute spontaneous aneurysmal subarachnoid hemorrhage.
据报道，危重症患者血浆肾上腺髓质素水平会升高。本研究检验了以下假设：急性自发性动脉瘤性蛛网膜下腔出血患者的血浆肾上腺髓质素水平显著升高，且可预测临床结局。评估了120例成年自发性动脉瘤性蛛网膜下腔出血患者和120名健康志愿者在研究期间的血浆肾上腺髓质素水平。记录了6个月时的死亡率和不良长期预后（格拉斯哥预后评分1 - 3分）。数据显示，与志愿者相比，患者入院时循环血浆肾上腺髓质素水平显著升高。在6个月时死亡或预后不良的患者中，血浆肾上腺髓质素水平显著高于幸存者和预后良好的患者。入院时的血浆肾上腺髓质素水平与使用神经外科医师世界联合会评分和Fisher评分评估的临床严重程度高度相关，是6个月死亡率和不良预后的独立危险因素，并且根据受试者工作特征曲线，其具有与神经外科医师世界联合会评分和Fisher评分相似的预测价值。一个联合逻辑回归模型并未显示肾上腺髓质素对神经外科医师世界联合会评分和Fisher评分有额外益处。因此，急性自发性动脉瘤性蛛网膜下腔出血患者入院时较高的血浆肾上腺髓质素水平与临床严重程度及更差的预后相关。
