Wang Kuo-Chuan, Tang Sung-Chun, Lee Jing-Er, Lai Dar-Ming, Huang Sheng-Jean, Hsieh Sung-Tsang, Jeng Jiann-Shing, Tu Yong-Kwang
Division of Neurosurgery, Department of Surgery, and.
J Neurosurg. 2014 Dec;121(6):1388-93. doi: 10.3171/2014.7.JNS131704. Epub 2014 Oct 3.
Experimental studies have demonstrated the crucial role of posthemorrhagic erythrocyte catabolism in the pathogenesis of subarachnoid hemorrhage (SAH). The authors of this study aimed to investigate the prognostic value of a series of CSF biomarkers linked to heme metabolism in SAH patients.
Patients with Fisher Grade III aneurysmal SAH undergoing early aneurysm obliteration were enrolled. The levels of heme oxygenase-1 (HO-1), oxyhemoglobin, ferritin, and bilirubin in intrathecal CSF were measured on the 7th day posthemorrhage. The associations of functional outcome with clinical and CSF parameters were analyzed.
The study included 41 patients (mean age 59 ± 14 years; 16 male, 25 female), 17 (41.5%) of whom had an unfavorable outcome (Glasgow Outcome Scale score ≤ 3) 3 months after SAH. In terms of the clinical data, age > 60 years, admission World Federation of Neurosurgical Societies Grade ≥ III, and the presence of acute hydrocephalus were independent factors associated with an unfavorable outcome. After adjusting for clinical parameters, a higher level of HO-1 appeared to be the most significant CSF parameter related to an unfavorable outcome among all tested CSF molecules (OR 0.934, 95% CI 0.883-0.989, p = 0.018). Further analysis using a generalized additive model identified a cutoff HO-1 value of 81.2 μM, with higher values predicting unfavorable outcome (82.4% accuracy).
The authors propose that the level of intrathecal CSF HO-1 at Day 7 post-SAH can be an effective outcome indicator in patients with Fisher Grade III aneurysmal SAH.
实验研究已证明出血后红细胞分解代谢在蛛网膜下腔出血（SAH）发病机制中的关键作用。本研究的作者旨在探讨一系列与血红素代谢相关的脑脊液生物标志物对SAH患者的预后价值。
纳入接受早期动脉瘤夹闭术的Fisher III级动脉瘤性SAH患者。在出血后第7天测量鞘内脑脊液中血红素加氧酶-1（HO-1）、氧合血红蛋白、铁蛋白和胆红素的水平。分析功能结局与临床及脑脊液参数之间的关联。
该研究纳入了41例患者（平均年龄59±14岁；男性16例，女性25例），其中17例（41.5%）在SAH后3个月预后不良（格拉斯哥预后评分≤3）。就临床数据而言，年龄>60岁、入院时世界神经外科协会分级≥III级以及存在急性脑积水是与预后不良相关的独立因素。在调整临床参数后，HO-1水平升高似乎是所有检测的脑脊液分子中与预后不良最相关的脑脊液参数（OR 0.934，95%CI 0.883-0.989，p = 0.018）。使用广义相加模型进行的进一步分析确定HO-1的临界值为81.2μM，值越高预示预后不良（准确率82.4%）。
作者提出，SAH后第7天鞘内脑脊液HO-1水平可作为Fisher III级动脉瘤性SAH患者有效的预后指标。
