Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan.
Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan.
J Clin Neurosci. 2022 Sep;103:131-140. doi: 10.1016/j.jocn.2022.07.016. Epub 2022 Jul 21.
Symptomatic vasospasm (SVS) is a major cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage (SAH), and serum sodium frequently decreases before SVS. Serum sodium changes might be regulated by sodium metabolism-related hormones. This multi-institutional prospective cohort study therefore investigated the measurement of sodium metabolism-related hormones to elucidate the pathophysiology of serum sodium changes in SAH.
SAH patients were treated with clipping or coiling from September 2017 to August 2020 at five hospitals. The laboratory data of 133 SAH patients were collected over 14 days and correlations between changes in serum sodium, sodium metabolism-related hormones (plasma adrenocorticotropic hormone (ACTH), serum cortisol, plasma arginine vasopressin (AVP)), and SVS were determined. Serum sodium concentrations were measured every day and serum sodium levels >135 mEq/L were maintained until day 14.
Of the 133 patients, 18 developed SVS within 14 days of subarachnoid hemorrhage onset (SVS group) and 115 did not suffer from SVS (non-SVS group). Circulating AVP, ACTH, and cortisol concentrations were significantly higher on day 1 in the SVS group compared with the non-SVS group. Fluctuations in serum sodium in the SVS group were significantly higher than those in the non-SVS group. There were antiparallel fluctuations in serum sodium and potassium from days 2 to 14.
Elevated levels of ACTH/cortisol and AVP on day 1 may be predictive markers for the occurrence of SVS. Multiple logistic regression analysis showed that serum sodium fluctuations were associated with SVS occurrence. Serum sodium fluctuations were associated with stress-related hormonal dynamics. (249 words).
症状性血管痉挛（SVS）是蛛网膜下腔出血（SAH）患者发病率和死亡率的主要原因，并且在 SVS 之前血清钠经常降低。血清钠变化可能受钠代谢相关激素的调节。因此，这项多机构前瞻性队列研究调查了钠代谢相关激素的测量，以阐明 SAH 中血清钠变化的病理生理学。
2017 年 9 月至 2020 年 8 月，五家医院对 133 例接受夹闭或栓塞治疗的 SAH 患者进行了治疗。在 14 天内收集了 133 例 SAH 患者的实验室数据，并确定了血清钠变化与钠代谢相关激素（血浆促肾上腺皮质激素（ACTH）、血清皮质醇、血浆血管加压素（AVP））之间的相关性。每天测量血清钠浓度，维持血清钠水平>135mEq/L，直至第 14 天。
在 133 例患者中，18 例在蛛网膜下腔出血发病后 14 天内发生 SVS（SVS 组），115 例未发生 SVS（非 SVS 组）。与非 SVS 组相比，SVS 组第 1 天的循环 AVP、ACTH 和皮质醇浓度显著升高。SVS 组的血清钠波动明显高于非 SVS 组。从第 2 天到第 14 天，血清钠和钾呈反平行波动。
第 1 天 ACTH/皮质醇和 AVP 水平升高可能是 SVS 发生的预测标志物。多变量逻辑回归分析显示，血清钠波动与 SVS 发生有关。血清钠波动与应激相关的激素动力学有关。（249 字）
