Walker Melanie, Federico Emma, Zunt Joseph R, Levitt Michael R, Johnston Christine M
Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA 98104, USA.
Stroke and Applied NeuroSciences Center, University of Washington School of Medicine, Seattle, WA 98104, USA.
Biomed Rep. 2024 Sep 26;21(6):177. doi: 10.3892/br.2024.1865. eCollection 2024 Dec.
Cerebral vasospasm (CV) is a critical determinant of outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). Despite advances in neurocritical care, modifiable risk factors for CV remain poorly understood, and identifying them could significantly enhance patient management and treatment strategies. The present study explored the potential link between the reactivation of herpes simplex virus type 1 (HSV-1), a common resident virus in cranial nerves, and CV severity. It was hypothesized that higher HSV-1 viral load in saliva may be associated with increased CV severity. Saliva samples were collected on days 4, 7, 10 and 14 post-aSAH, and HSV-1 DNA levels were measured using quantitative PCR. CV severity was assessed using the Lindegaard ratio (LR), with an LR >3 considered the diagnostic threshold for CV. A total of 36 patients were enrolled, and 139 saliva samples were collected. HSV-1 DNA was detected in 19.4% of samples (27/139), and 44% of patients (16/36) developed CV. HSV-1 seropositive patients made up 88.9% (32/36) of the cohort, with 50% exhibiting viral shedding during the study period. None of the HSV-1 seronegative patients (11.1%, 4/36) exhibited viral shedding or developed CV. Regression analysis showed a positive association between HSV-1 viral load and CV severity, with viral load explaining 27.8% of the variability (P=0.005). Age was also significant, with older patients experiencing less severe CV (P<0.001). Supervised machine learning identified viral load thresholds that aligned with standard LR values for moderate and severe CV. While the small sample size and observational design limit the generalizability of the results, these findings suggested that earlier detection and intervention for CV could be informed by assessing HSV-1 serostatus and monitoring viral activity through saliva samples or other non-invasive methods, highlighting the need for larger, controlled studies to validate these results.
脑血管痉挛（CV）是动脉瘤性蛛网膜下腔出血（aSAH）患者预后的关键决定因素。尽管神经重症监护取得了进展，但CV的可改变风险因素仍知之甚少，识别这些因素可显著改善患者管理和治疗策略。本研究探讨了1型单纯疱疹病毒（HSV-1）（一种常见的颅神经常驻病毒）再激活与CV严重程度之间的潜在联系。研究假设唾液中较高的HSV-1病毒载量可能与CV严重程度增加有关。在aSAH后的第4、7、10和14天收集唾液样本，并使用定量PCR测量HSV-1 DNA水平。使用Lindegaard比值（LR）评估CV严重程度，LR>3被视为CV的诊断阈值。共纳入36例患者，收集了139份唾液样本。19.4%的样本（27/139）检测到HSV-1 DNA，44%的患者（16/36）发生CV。HSV-1血清阳性患者占队列的88.9%（32/36），50%在研究期间出现病毒脱落。所有HSV-1血清阴性患者（11.1%，4/36）均未出现病毒脱落或发生CV。回归分析显示HSV-1病毒载量与CV严重程度呈正相关，病毒载量解释了27.8%的变异性（P=0.005）。年龄也有显著影响，老年患者的CV严重程度较轻（P<0.001）。监督机器学习确定了与中度和重度CV的标准LR值一致的病毒载量阈值。虽然小样本量和观察性设计限制了结果的普遍性，但这些发现表明，通过评估HSV-1血清状态并通过唾液样本或其他非侵入性方法监测病毒活性，可以为CV的早期检测和干预提供依据，强调需要进行更大规模的对照研究来验证这些结果。
