早期白细胞增多症和高敏C反应蛋白升高对蛛网膜下腔出血后迟发性脑缺血和神经功能结局的影响。
Impact of Early Leukocytosis and Elevated High-Sensitivity C-Reactive Protein on Delayed Cerebral Ischemia and Neurologic Outcome After Subarachnoid Hemorrhage.
作者信息
Srinivasan Anirudh, Aggarwal Ashish, Gaudihalli Sachin, Mohanty Manju, Dhandapani Manju, Singh Harminder, Mukherjee Kanchan K, Dhandapani Sivashanmugam
机构信息
Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
World Neurosurg. 2016 Jun;90:91-95. doi: 10.1016/j.wneu.2016.02.049. Epub 2016 Feb 18.
BACKGROUND
The role of inflammatory response in the pathophysiology of subarachnoid hemorrhage (SAH) is being increasingly recognized. This study analyzed the impact of cellular and biochemical markers of early inflammatory response to ictus on outcome after SAH.
METHODS
Patients with SAH were prospectively studied for markers of early cellular, biochemical, and cytotoxic inflammatory response, including total leukocyte count (TLC), high-sensitivity C-reactive protein (hs-CRP), and lactate dehydrogenase. The relationship of these markers to delayed cerebral ischemia (DCI), new infarct, and Glasgow Outcome Scale (GOS) score at 3 months was studied.
RESULTS
The study comprised 246 patients. Of patients, 94 who developed DCI had a significantly higher TLC [± SD] (11.2 × 10(3)/mm(3) [± 4.0] vs. 9.4 × 10(3)/mm(3) [± 2.9], P = 0.001) and 62 with new infarct had significantly higher TLC (11.0 × 10(3)/mm(3) [± 3.6] vs. 9.8 × 10(3)/mm(3) [± 3.4], P = 0.05). GOS score had a significant inverse relationship to TLC at admission. The mean TLC [± SD] was 12.7 × 10(3)/mm(3) [± 4.2], 11.7 × 10(3)/mm(3) [± 3.1], 10.2 × 10(3)/mm(3) [± 3.4], and 9.3 × 10(3)/mm(3) [± 2.8] among patients with GOS scores of 1, 3, 4, and 5 (P < 0.001). hs-CRP showed a trend of an inverse relationship to GOS score in univariate analysis. Lactate dehydrogenase had no relationship with any outcome parameter. In multivariate analysis, higher admission TLC had a significant association with DCI (P = 0.01) and poorer GOS score (P < 0.001), and higher hs-CRP had a significant association with poorer GOS score (P = 0.05).
CONCLUSIONS
A leukocytosis response to ictus seems to have a significant independent association with both DCI and poor GOS score, and hs-CRP level had a significant independent association with poor GOS score, indicating preeminence of early cellular response in SAH pathophysiology.
背景
炎症反应在蛛网膜下腔出血（SAH）病理生理学中的作用日益受到认可。本研究分析了SAH发作时早期炎症反应的细胞和生化标志物对预后的影响。
方法
对SAH患者进行前瞻性研究，检测早期细胞、生化和细胞毒性炎症反应标志物，包括白细胞总数（TLC）、高敏C反应蛋白（hs-CRP）和乳酸脱氢酶。研究这些标志物与延迟性脑缺血（DCI）、新发梗死以及3个月时格拉斯哥预后量表（GOS）评分之间的关系。
结果
本研究共纳入246例患者。发生DCI的94例患者的TLC[±标准差]显著更高（11.2×10³/mm³[±4.0]对9.4×10³/mm³[±2.9]，P = 0.001），新发梗死的62例患者的TLC显著更高（11.0×10³/mm³[±3.6]对9.8×10³/mm³[±3.4]，P = 0.05）。入院时GOS评分与TLC呈显著负相关。GOS评分为1、3、4和5的患者的平均TLC[±标准差]分别为12.7×10³/mm³[±4.2]、11.7×10³/mm³[±3.1]、10.2×10³/mm³[±3.4]和9.3×10³/mm³[±2.8]（P < 0.001）。单因素分析中，hs-CRP与GOS评分呈负相关趋势。乳酸脱氢酶与任何预后参数均无关联。多因素分析中，入院时较高的TLC与DCI显著相关（P = 0.01）且GOS评分较差（P < 0.001），较高的hs-CRP与GOS评分较差显著相关（P = 0.05）。
结论
发作时的白细胞增多反应似乎与DCI和较差的GOS评分均存在显著独立关联，hs-CRP水平与较差的GOS评分存在显著独立关联，表明早期细胞反应在SAH病理生理学中占主导地位。
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