Ioannoni Eleonora, Grande Giuseppe, Olivi Alessandro, Antonelli Massimo, Caricato Anselmo, Montano Nicola
Departments of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Rome.
Departments of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Rome.
Surg Neurol Int. 2020 Mar 6;11:39. doi: 10.25259/SNI_552_2019. eCollection 2020.
A hyperlactemia may occur in the presence of tissue hypoperfusion, in diseases affecting metabolism and in cases of malignant neoplasm. However, the factors affecting the serum lactate levels in patients submitted to craniotomy for the resection of an intracranial tumor have been investigated only marginally. Here, we assessed the factors possibly affecting the levels of serum lactate in intracranial tumors and carried out a thorough literature review on this topic.
All patients submitted to elective craniotomy from January 2017 to August 2018 for the resection of a glioblastoma (GBM; 101 cases) and a benign meningioma (WHO I; 105 cases) were included in this study. The sex, age, histological diagnosis, body mass index (BMI), and diabetes were assessed as possible factors affecting the level of the preoperative and postoperative serum lactate in these patients.
We found that preoperative hyperlactemia (> 2 mmol/l) was more frequent in patients with GBM than in patients with meningioma ( = 0.0003). Moreover, a strong correlation between a preoperative lactemia and postoperative lactemia ( < 0.0001) was observed. On univariate analysis, we found increased preoperative serum lactate levels in GBM patients ( = 0.0022) and in patients with a BMI ≥30 ( = 0.0068). Postoperative serum lactate levels were significantly higher in GBM patients ( = 0.0003). On multivariate logistic regression analysis, a diagnosis of GBM was an independent factor for higher level of preoperative ( = 0.0005) and postoperative ( < 0.0001) serum lactate.
The malignant phenotype of GBM is the strongest factor associated with a pre- and postoperative hyperlactemia in patients submitted to craniotomy for the resection of an intracranial tumor.
组织灌注不足、影响代谢的疾病以及恶性肿瘤患者均可能出现高乳酸血症。然而，针对接受开颅手术切除颅内肿瘤患者血清乳酸水平的影响因素，相关研究甚少。在此，我们评估了可能影响颅内肿瘤患者血清乳酸水平的因素，并对该主题进行了全面的文献综述。
本研究纳入了2017年1月至2018年8月期间接受择期开颅手术切除胶质母细胞瘤（GBM；101例）和良性脑膜瘤（世界卫生组织I级；105例）的所有患者。评估了性别、年龄、组织学诊断、体重指数（BMI）和糖尿病等因素，以确定其对这些患者术前和术后血清乳酸水平的可能影响。
我们发现，GBM患者术前高乳酸血症（>2 mmol/L）的发生率高于脑膜瘤患者（P = 0.0003）。此外，观察到术前乳酸血症与术后乳酸血症之间存在强相关性（P < 0.0001）。单因素分析显示，GBM患者（P = 0.0022）和BMI≥30的患者（P = 0.0068）术前血清乳酸水平升高。GBM患者术后血清乳酸水平显著更高（P = 0.0003）。多因素逻辑回归分析显示，GBM诊断是术前（P = 0.0005）和术后（P < 0.0001）血清乳酸水平升高的独立因素。
GBM的恶性表型是接受开颅手术切除颅内肿瘤患者术前和术后高乳酸血症的最强相关因素。
