Rajapathy Senthil Kumar, Idris Zamzuri, Kandasamy Regunath, Hieng Albert Wong Sii, Abdullah Jafri Malin
Department of Neurosciences, Universiti Sains Malaysia, Jalan Raja Perempuan Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia.
Department of Neurosurgery, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia.
Malays J Med Sci. 2017 May;24(3):51-65. doi: 10.21315/mjms2017.24.3.7. Epub 2017 Jun 30.
Spontaneous intracerebral haemorrhage (SICH) has emerged as one of the most devastating forms of stroke in recent decades. This disease is noted to carry a 30-day mortality rate of approximately 45%. An increasing number of studies have implicated a complex immune-mediated and inflammation-mediated cascade of responses in the pathophysiology of SICH and the resultant neurologic outcome. Several clinical studies have demonstrated an association between inflammatory markers and outcome in patients with SICH. However, the exact relationship between serum biomarkers and functional outcomes amongst survivors has not been clearly elucidated. This study aimed to evaluate the changes in peripheral leukocyte count (WBC count) and C-reactive protein (CRP) levels in patients with SICH and to correlate these findings with survival and functional outcome.
A prospective, descriptive and correlational study was conducted at Sarawak General Hospital (SGH) over the span of two years (April 2013-April 2015). Patients aged between 30 years and 75 years with supratentorial intracerebral bleed secondary to uncontrolled hypertension were recruited in this study. Data pertaining to the demography, clinical and radiological parameters, peripheral WBC count and CRP levels were obtained. Mortality and functional outcomes were determined at 6 months post ictus. Patients were recruited following the fulfilment of exclusion and inclusion criteria, and all obtained data were analysed with the Statistical Package for Social Sciences (SPSS) for Windows version 21.0.
A total of 60 patients with a mean age of 56 years were recruited in this study. We found that approximately 16 patients were less than or equal to 50 years old (26.7%) and that 44 patients belonged to the older age group of above 50 years (73.3%). The Glasgow Coma Scale (GCS) score on admission ranged from 9 to 14/15 with a median value of 11/15. The mean clot volume was 20.1 cm. The GCS score on admission and clot volume were significantly associated with the Glasgow Outcome Scale (GOS) at 6 months and overall survival ( < 0.05). The elevated WBC count and CRP level on admission and at 72 hours post admission were significantly associated with GOS at 6 months and overall survival ( < 0.05). Thus, the GCS score, clot volume, WBC count and CRP levels on admission and at 72 hours post admission can be used to predict functional outcome at 6 months and overall survival in patients with SICH.
We could conclude via this study that for patients with SICH, the main determinants or predictors of functional outcome at 6 months and overall survival were noted to be the GCS score on admission, clot size, WBC count and CRP levels on admission and at 72 hours post admission.
近几十年来，自发性脑出血（SICH）已成为最具毁灭性的中风形式之一。据指出，这种疾病的30天死亡率约为45%。越来越多的研究表明，在SICH的病理生理学及由此产生的神经学结果中，存在复杂的免疫介导和炎症介导的反应级联。多项临床研究已证明炎症标志物与SICH患者的预后之间存在关联。然而，血清生物标志物与幸存者功能结局的确切关系尚未明确阐明。本研究旨在评估SICH患者外周白细胞计数（白细胞计数）和C反应蛋白（CRP）水平的变化，并将这些结果与生存率和功能结局相关联。
在两年时间（2013年4月至2015年4月）内，于砂拉越总医院（SGH）进行了一项前瞻性、描述性和相关性研究。本研究招募了年龄在30岁至75岁之间、因未控制的高血压导致幕上脑出血的患者。获取了有关人口统计学、临床和放射学参数、外周白细胞计数和CRP水平的数据。在发病后6个月确定死亡率和功能结局。在满足排除和纳入标准后招募患者，并使用Windows版社会科学统计软件包（SPSS）21.0对所有获得的数据进行分析。
本研究共招募了60例平均年龄为56岁的患者。我们发现，约16例患者年龄小于或等于50岁（26.7%），44例患者属于50岁以上的老年组（73.3%）。入院时格拉斯哥昏迷量表（GCS）评分范围为9至14/15，中位数为11/15。平均凝血块体积为20.1立方厘米。入院时的GCS评分和凝血块体积与6个月时的格拉斯哥预后量表（GOS）及总体生存率显著相关（<0.05）。入院时及入院后72小时白细胞计数和CRP水平升高与6个月时的GOS及总体生存率显著相关（<0.05）。因此，入院时及入院后72小时的GCS评分、凝血块体积、白细胞计数和CRP水平可用于预测SICH患者6个月时的功能结局及总体生存率。
通过本研究我们可以得出结论，对于SICH患者，6个月时功能结局及总体生存率的主要决定因素或预测指标为入院时的GCS评分、凝血块大小、入院时及入院后72小时的白细胞计数和CRP水平。
