Zheng Jianfeng, Cheng Chongjie, Zhou Chao, Chen Hong, Guo Zongduo, Sun Xiaochuan
Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, People's Republic of China.
Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, People's Republic of China.
World Neurosurg. 2018 Jun;114:e1161-e1167. doi: 10.1016/j.wneu.2018.03.165. Epub 2018 Mar 31.
More nonaneurysmal subarachnoid hemorrhage (NaSAH) are found in clinical practice. However, the precise mechanisms in which d-dimer level is associated with clinical condition in patients with NaSAH remain unclear. But even more, the data assessing the risk of clinical course in the patients with NaSAH are scarce. Our objective was to investigate whether d-dimer levels correlated with complication and outcome in patients with NaSAH.
Between February 2013 and May 2017, 92 patients suffering from NaSAH were treated in our hospital. Patient characteristics, radiologic features, laboratory findings, complications, and outcomes were analyzed retrospectively. Patients were stratified into the perimesencephalic (PM) subarachnoid hemorrhage (SAH) group and the nonperimesencephalic (NPM) SAH group according to the bleeding type, and the NPM-SAH group was further divided into 2 subgroups into the NPM-elevated group and the NPM-normal group based on the value of the d-dimer. After statistical analysis, the NPM-SAH and PM-SAH groups were compared; the same was true for the NPM-elevated group and the NPM-normal group.
The rate of complications in the NPM-SAH group was higher than in the PM-SAH group, including early hydrocephalus, delayed cerebral ischemia, clinical vasospasm, pneumonia, and hyponatremia. Our results showed that d-dimer levels in patients with NPM-SAH were more elevated than in those with PM-SAH. Further analysis of subgroups demonstrated that patients with elevated d-dimer levels had a higher incidence of complications than those with normal d-dimer levels, especially the risks of shunt-dependent hydrocephalus and pneumonia. In addition, disability, and even death, could be seen in patients with higher levels of d-dimer, but the long-term outcomes were not particularly obvious between these groups.
Elevated d-dimer levels on admission were significantly associated with complication in patients with NPM-SAH. In addition to conventional radiologic diagnosis, d-dimer levels can increase the ability of a rapid differential diagnosis between NPM-SAH and PM-SAH.
临床实践中发现更多的非动脉瘤性蛛网膜下腔出血（NaSAH）。然而，NaSAH患者中D-二聚体水平与临床状况相关的精确机制仍不清楚。而且，评估NaSAH患者临床病程风险的数据也很匮乏。我们的目的是研究NaSAH患者的D-二聚体水平是否与并发症及预后相关。
2013年2月至2017年5月期间，我院收治了92例NaSAH患者。对患者的特征、影像学特征、实验室检查结果、并发症及预后进行回顾性分析。根据出血类型将患者分为中脑周围（PM）蛛网膜下腔出血（SAH）组和非中脑周围（NPM）SAH组，NPM-SAH组根据D-二聚体值进一步分为NPM升高组和NPM正常组。经过统计分析，比较NPM-SAH组和PM-SAH组；NPM升高组和NPM正常组也进行同样的比较。
NPM-SAH组的并发症发生率高于PM-SAH组，包括早期脑积水、迟发性脑缺血、临床血管痉挛、肺炎和低钠血症。我们的结果显示，NPM-SAH患者的D-二聚体水平高于PM-SAH患者。亚组进一步分析表明，D-二聚体水平升高的患者并发症发生率高于D-二聚体水平正常的患者，尤其是依赖分流的脑积水和肺炎的风险。此外，D-二聚体水平较高的患者可能出现残疾甚至死亡，但这些组之间的长期预后并不特别明显。
入院时D-二聚体水平升高与NPM-SAH患者的并发症显著相关。除了传统的影像学诊断外，D-二聚体水平可以提高快速鉴别NPM-SAH和PM-SAH的能力。
