Kho Giat Seng, Kandasamy Regunath, Bujang Mohamad Adam, Swammy Mummedy, Mustapha Muzaimi, Abdullah Jafri Malin
Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
Department of Neurosurgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia.
Malays J Med Sci. 2021 Dec;28(6):42-54. doi: 10.21315/mjms2021.28.6.5. Epub 2021 Dec 22.
Nitric oxide (NO) is involved in a multitude of physiological processes in the central nervous system (CNS). Given the ubiquitous nature of NO and its involvement in various vital processes, nitric oxide metabolite (NOx) has been investigated as a biomarker in CNS diseases. This study aims to investigate the ratio of NOx levels and serum in cerebrospinal fluid (CSF) in patients with spontaneous subarachnoid haemorrhage (SAH). The associations among these markers with clinical outcomes were also studied.
A prospective cohort study was conducted over a 2-year period (May 2013-May 2015) to investigate the levels of NOx in the CSF and serum of patients with radiologically confirmed aneurysmal SAH. NOx samples and all relevant data were collected from the patients on admission and serially over 5 days. On admission, NOx levels were compared between the groups of patients, who were divided as per the World Federation Neurosurgeons Score (WFNS) grading scale, Fisher scale, occurrence of vasospasm on transcranial doppler (TCD), and Glasgow outcome scale (GOS) upon discharge and at 6 months follow-up. The ratios of CSF-to-serum were calculated and correlated with SAH severity and the outcome parameters listed above.
The patients ( 40) had a mean (SD) age of 58.2 (11.8) years old. The majority (65%) had a higher severity of SAH (WFNS score 3-5). On evaluation of the CT scan findings, 74% had outcomes equivalent to 4 on the Fisher scale. Vasospasm was detected via TCD in nearly half (45%) of the cohort during the study period; 80% were noted to have a poor outcome (GOS 1-3) at discharge; this persisted at 6 months follow-up. Comparison of NOx levels in the CSF/serum ratio was based on the incidence of vasospasm and severity of outcome (GOS) for day-1 and day-4. Statistically significant results were evident for patients with better outcomes, high severity grading, and the presence of vasospasm (-values: 0.031, 0.034 and 0.043, respectively).
Elevated NOx levels in CSF and serum and reductions in the ratio of NOx in CSF/serum were found to be associated with severity, occurrence of vasospasm and clinical outcome in aneurysmal SAH patients. This indicates the possible role of NOx as a biomarker to assess severity and prognosis in patients with SAH.
一氧化氮（NO）参与中枢神经系统（CNS）的多种生理过程。鉴于NO的普遍存在及其参与各种重要过程，一氧化氮代谢物（NOx）已被作为中枢神经系统疾病的生物标志物进行研究。本研究旨在调查自发性蛛网膜下腔出血（SAH）患者脑脊液（CSF）与血清中NOx水平的比值，并研究这些标志物与临床结局之间的关联。
进行了一项为期2年（2013年5月至2015年5月）的前瞻性队列研究，以调查经放射学证实的动脉瘤性SAH患者脑脊液和血清中的NOx水平。在患者入院时及之后连续5天收集NOx样本和所有相关数据。入院时，根据世界神经外科医师联合会（WFNS）分级量表、Fisher量表、经颅多普勒（TCD）检测的血管痉挛发生率以及出院时和6个月随访时的格拉斯哥预后量表（GOS）对患者进行分组，比较各组患者的NOx水平。计算脑脊液与血清的比值，并将其与SAH严重程度及上述结局参数相关联。
40例患者的平均（标准差）年龄为58.2（11.8）岁。大多数患者（65%）的SAH严重程度较高（WFNS评分3 - 5分）。根据CT扫描结果评估，74%的患者Fisher量表评分为4分。在研究期间，通过TCD检测到近一半（45%）的队列患者发生血管痉挛；80%的患者出院时预后不良（GOS 1 - 3）；6个月随访时仍如此。基于第1天和第4天的血管痉挛发生率和结局严重程度（GOS），比较脑脊液/血清中NOx水平的比值。结局较好、严重程度分级高且存在血管痉挛的患者有统计学意义的结果明显（P值分别为0.031、0.034和0.043）。
发现脑脊液和血清中NOx水平升高以及脑脊液/血清中NOx比值降低与动脉瘤性SAH患者的严重程度、血管痉挛的发生及临床结局相关。这表明NOx可能作为评估SAH患者严重程度和预后的生物标志物。
