[1]阮　东　王　芳　郭丽蕊　彭红梅　陈谦学　刘宝辉.C-反应蛋白与动脉瘤性蛛网膜下腔出血临床预后的关系[J].中国临床神经外科杂志,2017,(09):626-629.[doi:10.13798/j.issn.1009-153X.2017.09.006]
　RUAN Dong,WANG Fang,GUO Li-rui,et al.Relationship between serum level of C-reactive protein and prognoses in patients with aneurysmal subarachnoid hemorrhage[J].,2017,(09):626-629.[doi:10.13798/j.issn.1009-153X.2017.09.006]
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C-反应蛋白与动脉瘤性蛛网膜下腔出血临床预后的关系()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2017年09期
页码:
626-629
栏目:
论著
出版日期:
2017-09-25

文章信息/Info

Title:
Relationship between serum level of C-reactive protein and prognoses in patients with aneurysmal subarachnoid hemorrhage
文章编号:
1009-153X（2017）09-0626-04
作者:
阮　东　王　芳　郭丽蕊　彭红梅　陈谦学　刘宝辉
437100 湖北，咸宁市中心医院（湖北科技学院附属第一医院）神经外科（阮　东）；430060 武汉，武汉大学人民医院神经外科
Author(s):
RUAN Dong1;  WANG Fang2;  GUO Li-rui2;  PENG Hong-mei2;  CHEN Qian-xue2;  LIU Bao-hui2
1. Department of Neurosurgery, Xianning Central Hospital, Xianning 437100, China; 2. Department of Neurosurgery, Renmin Hospital, Wuhan University, Wuhan 430060, China
关键词:
动脉瘤性蛛网膜下腔出血; C-反应蛋白; 血清; 预后
Keywords:
Intracranial aneurysm;  Subarachnoid hemorrhage;  C-reactive protein;  Prognosis
分类号:
R 743.9
DOI:
10.13798/j.issn.1009-153X.2017.09.006
文献标志码:
A
摘要:
目的 探讨动脉瘤性蛛网膜下腔出血（aSAH）血清C-反应蛋白（CRP）动态变化趋势及其与临床预后的关系。方法 2014年1月至2015年8月前瞻性收集符合标准的aSAH 108例，发病72 h内行夹闭术（72例）或血管内栓塞（36例）。术后3个月采用GOS评分评估预后，4~5分为预后良好，1~3分为预后不良。入院时、术后1、3、5、7 d及出院当天，采集清晨空腹静脉血，检测血清CRP水平。采用多因素Logistic回归分析检验预后不良危险因素。结果 108例中，预后良好68例，预后不良40例。多因素Logistic回归分析显示，术后1 、3 d血清CRP水平增高是aSAH不良预后的独立危险因素。受试者工作特征曲线分析结果 术后3 d血清CRP水平[曲线下面积（AUC）=0.823]与术后1 d（AUC=0.861）相比，对不良预后的发生具有更好的预测价值。术后1 d血清CRP与入院时GCS评分、入院时Fisher评分和入院时Hunt-Hess分级均无明显相关性（P>0.05）。术后3 d血清CRP水平与入院时GCS评分无明显相关性，但与入院时Fisher评分（r=0.28；P<0.05）、入院时Hunt-Hess分级（r=0.42；P<0.05）存在明显相关性。结论 术后3 d血清CRP水平升高是aSAH不良预后的独立危险因素，能为不良预后的识别提供临床指导。
Abstract:
Objective To investigate the relationship between the serum level of C-reactive protein (CRP) and prognoses in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods The serum levels of CRP were determined before and 1, 3, 5 and 7 days after the operation and on discharge from hospital in 108 patients with aSAH from January, 2014 to August, 2015. Univariate and multivariate logistic regression analyses were used to explore the relationship of the serum levels of CRP with clinical outcomes. Receiver operating characteristic (ROC) curves were obtained to investigate the value of CRP to predicting the prognoses in the patients with aSAH. Results Of 108 patients, 68 patients had good outcome and 40 had poor outcome according to GOS score 3 months after operation. The serum levels of CRP were significantly higher in 40 patients with poor outcomes than those in 68 patients with good outcomes 1, 3, 5 and 7 days after the surgery as well as on discharge. The serum levels of CRP reached the top 1 day after the operation and then declined rapidly in the patients with poor outcomes. The multivariate analysis showed that the serum levels of CRP 1 and 3 days after the operation were significant related to poor outcomes in the patients with aSAH. The areas under the curve (AUV) for the serum levels of 1 and 3 days after the operation were 0.823 and 0.861, respectively. The serum level of CRP 3 days after the operation was positively related to the preoperative Hunt-Hess grades (r=0.42; P<0.05) and preoperative Fisher score (r=0.28; P<0.05) in the patients with aSAH. Conclusions It is suggested that the serum levels of CRP 1 and 3 days after the operation are of important value to predicting the prognoses in the patients with aSAH.

参考文献/References:

[1] Inamasu J, Sadato A, Oheda M, et al. Improvement in patient outcomes following endovascular treatment of WFNS grade Ⅴsubarachnoid haemorrhage from 2000 to 2014 [J]. J Clin Neurosci, 2016, 27: 114-118.
[2] Dhandapani S, Pal SS, Gupta SK, et al. Does the impact of elective temporary clipping on intraoperative rupture really influence neurological outcome after surgery for ruptured anterior circulation aneurysms--a prospective multivariate study [J]. Acta Neurochir (Wien), 2013, 155(2): 237-246.
[3] Tewari M, Aggarwal A, Mathuriya S, et al. The outcome after aneurysmal sub arachnoid hemorrhage: a study of various factors [J]. Ann Neurosci, 2015, 22(2): 78-80.
[4] Dhandapani S, Goudihalli S, Mukherjee KK, et al. Prospec- tive study of the correlation between admission plasma homocysteine levels and neurological outcome following subarachnoid hemorrhage: a case for the reverse epidemio- logy paradox [J]? Acta Neurochir (Wien), 2015, 157(3): 399-407.
[5] Garg K, Sinha S, Kale SS, et al. Role of simvastatin in pre- vention of vasospasm and improving functional outcome after aneurysmal sub-arachnoid hemorrhage: a prospective, randomized, double-blind, placebo-controlled pilot trial [J]. Br J Neurosurg, 2013, 27(2): 181-186.
[6] 何骏驰，罗良生. 动脉瘤性蛛网膜下腔出血后早期脑损伤 的研究进展[J]. 东南大学学报（医学版），2015，34（2）： 308-312.
[7] 付　超，赵丛海. 动脉瘤性蛛网膜下腔出血后早期脑损伤 病理生理的研究进展[J]. 中华神经医学杂志， 2013，12 （10）：1073-1076.
[8] 姚鹏飞，黄清海. 炎性反应在颅内动脉瘤生成和破裂中作 用的研究进展[J]. 中国脑血管病杂志，2015，12：205-209.
[9] Fountas KN, Tasiou A, Kapsalaki EZ, et al. Serum and cerebrospinal fluid C-reactive protein levels as predictors of vasospasm in aneurysmal subarachnoid hemorrhage [J]. Neurosurg Focus, 2009, 26(5): E22.
[10] Hwang SH, Park YS, Kwon JT, et al. Significance of C-reactive protein and transcranial Doppler in cerebral vasospasm following aneurysmal subarachnoid hemorrhage [J]. J Korean Neurosurg Soc, 2013, 54(4): 289-295.
[11] Mirzayan MJ, Gharabaghi A, Samii M, et al. Response of C-reactive protein after craniotomy for microsurgery of intracranial tumors [J]. Neurosurgery, 2007, 60(4): 621-625, 625.
[12] Csajbok LZ, Nylen K, Ost M, et al. In-hospital C-reactive protein predicts outcome after aneurysmal subarachnoid haemorrhage treated by endovascular coiling [J]. Acta Anaesthesiol Scand, 2015, 59(2): 255-264.
[13] Turner CL, Budohoski K, Smith C, et al. Elevated baseline C-reactive protein as a predictor of outcome after aneury- smal subarachnoid hemorrhage: data from the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) Trial [J]. Neurosurgery, 2015, 77(5): 786-792; discussion 792-793.
[14] Hwang SH, Park YS, Kwon JT, et al. Significance of C-reactive protein and transcranial Doppler in cerebral vasospasm following aneurysmal subarachnoid hemorrhage [J]. J Korean Neurosurg Soc, 2013, 54(4): 289-295.
[15] Jeon YT, Lee JH, Lee H, et al. The postoperative C-reactive protein level can be a useful prognostic factor for poor out- come and symptomatic vasospasm in patients with aneury- smal subarachnoid hemorrhage [J]. J Neurosurg Anesthe- siol, 2012, 24(4): 317-324.

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金（81372683，81572489） 作者单位：437100 湖北，咸宁市中心医院（湖北科技学院附属第一医院）神经外科（阮　东）；430060 武汉，武汉大学人民医院神经外科（王　芳、郭丽蕊、彭红梅、陈谦学、刘宝辉） 通讯作者：陈谦学，E-mail：chenqx666@sohu.com
更新日期/Last Update: 1900-01-01