Xi'an Gaoxin Hospital, China.
XD Group Hospital, China.
Folia Neuropathol. 2024;62(2):147-155. doi: 10.5114/fn.2023.132782.
The aim of the study was to explore the relationship between astrocyte damage and different levels of cerebrospinal fluid markers and prognosis in patients with subarachnoid hemorrhage (SAH).
A total of 168 SAH patients diagnosed and treated in the emergency department of our hospital during the period October 2019 to February 2022 were randomly selected as the study subjects. The severity of these patients' condition was evaluated by Hunt-Hess grading and these subjects were graded as the low-level group (78 patients) and high-level group (90 patients) according to the evaluation results. The Extended Disability Status Scale (EDSS) score was employed to evaluate the astrocyte damage. The content of atypical chemokine receptor 3 (ACKR3), Connexin 43 (Cx43), oxygenated hemoglobin (HbO 2 ), and endothelin (ET) in cerebrospinal fluid was measured. The relationship between the content of ACKR3, Cx43, HbO 2 , and ET in cerebrospinal fluid with EDSS score was analyzed through Pearson correlation analysis. Multivariate logistic regression analysis was adopted to analyze the risk factors.
ACKR3 was mainly expressed in the cytoplasm of cerebrospinal fluid monocytes, and Cx43 was mainly expressed in the cell membrane and cytoplasm. Patients in the high-level group had markedly higher expression rates of ACKR3 and Cx43 positive cells in cerebrospinal fluid than those in the low-level group ( p < 0.05). Patients in the high-level group had higher content of HbO 2 and ET in cerebrospinal fluid and EDSS score than patients in the low-level group ( p < 0.05). The content of ACKR3, Cx43, HbO 2 , and ET in cerebrospinal fluid of SAH patients was positively correlated with EDSS scores ( p < 0.05). Systolic blood pressure, Hunt-Hess grade, rebleeding, emotional control, EDSS score, ACKR3, Cx43 positive cell rate, and HbO 2 and ET expression levels were independent risk factors for the prognosis of SAH patients ( p < 0.05).
Astrocyte damage in SAH patients was positively correlated with the content of ACKR3, Cx43, HbO 2 , and ET in cerebrospinal fluid. These indicators increased significantly with the increasing severity of the disease, and had certain value in reflecting the patient's condition. Astrocyte damage combined with cerebrospinal fluid markers had potential value in evaluating the severity and prognosis of patients.
本研究旨在探讨蛛网膜下腔出血（SAH）患者星形胶质细胞损伤与不同水平的脑脊液标志物及预后的关系。
选取我院急诊科 2019 年 10 月至 2022 年 2 月收治的 168 例 SAH 患者为研究对象，采用 Hunt-Hess 分级评估患者病情严重程度，根据评估结果将患者分为低水平组（78 例）和高水平组（90 例）。采用扩展残疾状况量表（EDSS）评分评估星形胶质细胞损伤程度，检测脑脊液中趋化因子受体 3（ACKR3）、连接蛋白 43（Cx43）、氧合血红蛋白（HbO 2 ）和内皮素（ET）的含量，采用 Pearson 相关分析分析脑脊液 ACKR3、Cx43、HbO 2 、ET 含量与 EDSS 评分的关系。采用多因素 logistic 回归分析影响预后的危险因素。
ACKR3 主要表达于脑脊液单核细胞胞浆，Cx43 主要表达于细胞膜和胞浆。高水平组患者脑脊液中 ACKR3 和 Cx43 阳性细胞表达率明显高于低水平组（p<0.05）。高水平组患者脑脊液中 HbO 2 和 ET 含量及 EDSS 评分均高于低水平组（p<0.05）。SAH 患者脑脊液中 ACKR3、Cx43、HbO 2 、ET 含量与 EDSS 评分呈正相关（p<0.05）。收缩压、Hunt-Hess 分级、再出血、情绪控制、EDSS 评分、ACKR3、Cx43 阳性细胞率及 HbO 2 和 ET 表达水平是影响 SAH 患者预后的独立危险因素（p<0.05）。
SAH 患者星形胶质细胞损伤与脑脊液中 ACKR3、Cx43、HbO 2 、ET 含量呈正相关，随着病情严重程度的增加而显著升高，对反映患者病情具有一定价值。星形胶质细胞损伤联合脑脊液标志物对评估患者病情严重程度和预后具有潜在价值。
