Hugelshofer Michael, Sikorski Christopher M, Seule Martin, Deuel Jeremy, Muroi Carl I, Seboek Martina, Akeret Kevin, Buzzi Raphael, Regli Luca, Schaer Dominik J, Keller Emanuela
Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
Neurointensive Care Unit, University Hospital of Zurich, Zurich, Switzerland.
World Neurosurg. 2018 Dec;120:e660-e666. doi: 10.1016/j.wneu.2018.08.141. Epub 2018 Aug 27.
Aneurysmal subarachnoid hemorrhage (aSAH) is often complicated by the occurrence of delayed ischemic neurologic deficits (DIND), which impairs the clinical outcome of patients. The release of oxyhemoglobin (oxyHb) from lysing erythrocytes into cerebrospinal fluid (CSF) may critically contribute to the development of DIND.
Ventricular CSF of 18 high-grade (Fisher 3 and 4) aSAH patients was sampled daily from external ventricular drains between days 0 and 14 after bleeding. CSF was spectrophotometrically analyzed with precise quantification of cell-free oxyHb levels.
OxyHb levels in CSF showed a delayed peak reaching the highest levels in the high-risk period for developing of DIND between days 3 and 14 after aneurysm rupture. Patients with DIND had a significantly higher cumulative oxyHb exposure within the first week after bleeding.
OxyHb levels in CSF may be useful as a biomarker to predict DIND in aSAH patients. The contribution of oxyHb in CSF to the pathogenesis of DIND should be further investigated as a potential therapeutic target.
动脉瘤性蛛网膜下腔出血（aSAH）常并发迟发性缺血性神经功能缺损（DIND），这会损害患者的临床预后。氧合血红蛋白（oxyHb）从裂解的红细胞释放到脑脊液（CSF）中可能是导致DIND发生的关键因素。
对18例高级别（Fisher 3级和4级）aSAH患者，在出血后0至14天期间，每天从脑室外引流管采集脑室CSF。采用分光光度法对CSF进行分析，精确量化无细胞oxyHb水平。
CSF中的oxyHb水平出现延迟峰值，在动脉瘤破裂后3至14天的DIND高发期达到最高水平。发生DIND的患者在出血后第一周内的累积oxyHb暴露量显著更高。
CSF中的oxyHb水平可能作为预测aSAH患者发生DIND的生物标志物。CSF中oxyHb对DIND发病机制的作用应作为潜在治疗靶点进一步研究。
