血清乳酸脱氢酶与磷酸盐比值作为破裂颅内动脉瘤显微夹闭术不良预后的独立预测指标：一项倾向评分匹配分析
Serum Lactate Dehydrogenase to Phosphate Ratio as an Independent Predictor for Adverse Outcome of Microsurgical Clipping for Ruptured Intracranial Aneurysm: A Propensity-Score Matching Analysis.
作者信息
Zheng Shufa, Zhang Yibin, Wang Haojie, Xie Xueling, Lin Yuanxiang, Yao Peisen, Lin Zhangya, Kang Dezhi
机构信息
Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China.
Fujian Provincial Clinical Research Center for Neurological Disease, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China.
出版信息
Brain Sci. 2022 Jun 4;12(6):737. doi: 10.3390/brainsci12060737.
Objective: In this study, we assessed the correlation between the lactate dehydrogenase (LDH) to phosphate ratio and the prognosis of microsurgical clippings for ruptured intracranial aneurysm (rIA) to test the hypothesis that the serum LDH to phosphate ratio could be a predictor of the outcome of microsurgical clipping for rIA. Methods: Records of rIA patients between 2012 and 2018 were retrospectively collected. Age, sex, Hunt-Hess grade, Fisher grade, medical history, aneurysm location, hydrocephalus, laboratory data including serum LDH, phosphate, and LDH to phosphate ratio, related complications, and the outcomes in 3 months were recorded. Results: A total of 1608 rIA patients in our institution were collected, and 856 patients treated by microsurgical clipping were enrolled. On admission, a significantly higher LDH-phosphate ratio was observed in patients with poor outcomes at 3 months (median ± SD, 200.175 ± 107.290 for mRS 0−2 vs. 323.826 ± 219.075 for mRS score 3−6; p = 0.000). An LDH to phosphate ratio of 226.25 in the receiver operating characteristic (ROC) curve was the optimal cutoff value to discriminate between good and poor outcomes at 3 months. The LDH to phosphate ratio ≥ 226.25 on admission was independently correlated with poor outcomes in rIA patients. In addition, Hunt and Hess grade, Fisher grade, pneumonia, and DIND were also independently correlated with poor outcomes. After removing the bias in essential clinical variables between patients with LDH to phosphate, ratio ≥ 226.25 versus <226.25 by PSM, the number of patients with poor outcomes at 3 months increased in patients with an LDH to phosphate ratio of ≥226.25 (p = 0.005). Conclusions: The LDH to phosphate ratio was a potential biomarker and could predict the unfavorable outcome of microsurgical clipping for rIA in 3 months, related to neuronal damage, cerebral hypoxia, and early brain injury after aneurysm ruptures.
目的
在本研究中，我们评估了乳酸脱氢酶（LDH）与磷酸盐比值和破裂颅内动脉瘤（rIA）显微手术夹闭预后之间的相关性，以检验血清LDH与磷酸盐比值可能是rIA显微手术夹闭结果预测指标的假设。方法：回顾性收集2012年至2018年rIA患者的记录。记录年龄、性别、Hunt-Hess分级、Fisher分级、病史、动脉瘤位置、脑积水、实验室数据（包括血清LDH、磷酸盐以及LDH与磷酸盐比值）、相关并发症以及3个月时的结局。结果：我们机构共收集了1608例rIA患者，其中856例接受了显微手术夹闭治疗。入院时，3个月结局较差的患者中观察到显著更高的LDH-磷酸盐比值（中位数±标准差，改良Rankin量表[mRS] 0−2分为200.175±107.290，而mRS评分3−6分为323.826±219.075；p = 0.000）。受试者工作特征（ROC）曲线中LDH与磷酸盐比值为226.25是区分3个月时良好和不良结局的最佳截断值。入院时LDH与磷酸盐比值≥226.25与rIA患者不良结局独立相关。此外，Hunt和Hess分级、Fisher分级、肺炎和延迟性缺血性神经功能障碍（DIND）也与不良结局独立相关。通过倾向评分匹配（PSM）消除LDH与磷酸盐比值≥226.25与＜226.25患者之间基本临床变量偏差后，LDH与磷酸盐比值≥226.25的患者3个月时不良结局患者数量增加（p = 0.005）。结论：LDH与磷酸盐比值是一种潜在的生物标志物，可预测rIA显微手术夹闭3个月时的不良结局，这与动脉瘤破裂后的神经元损伤、脑缺氧和早期脑损伤有关。
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