缺血修饰白蛋白评估动脉瘤性蛛网膜下腔出血患者迟发性脑缺血研究

Value of ischemia-modified albumin in evaluating delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage

摘要:

目的 探讨缺血修饰白蛋白（IMA）评估动脉瘤性蛛网膜下腔出血（aSAH）患者迟发性脑缺血（DCI）的价值及其与患者预后的关系。方法 选取198例aSAH患者，根据有无DCI把患者分为DCI组和无DCI组，测定血清IMA，同时使用经颅多普勒（TCD）监测大脑中动脉的平均血流速度（VMCA），比较两组脑血管痉挛发生率和血清IMA。结果 在7～10天时间段VMCA和血清IMA达到峰值，然后逐渐下降；在1～6天、7～10天、11～14天时间段，VMCA比较、血清IMA比较，差异均有统计学意义（P<0.05）。DCI组的CVS发生率高于无DCI组，并且DCI组的血清IMA水平高于无DCI组，差异均有统计学意义（P<0.05）。预后不良组的血清IMA[（64.28±5.94） U/ml]高于预后良好组[（45.46±5.72） U/ml]，差异有统计学意义（P<0.05）。结论 血清IMA水平与脑血管痉挛及预后密切相关，它可在一定程度上反应aSAH后脑缺血情况，对血管痉挛相关的DCI评估有重要价值，并且有助于判断预后。

Abstract:

Objective To investigate the value of ischemia-modified albumin (IMA) in evaluating delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) and its association with patient prognosis.Methods A total of 198 patients with aSAH were enrolled, and according to the presence or absence of DCI, these patients were divided into DCI group and non-DCI group. Serum IMA was measured, and transcranial Doppler was used to monitor the mean blood flow velocity of the middle cerebral artery (VMCA). The incidence rate of cerebral vasospasm (CVS) and serum IMA were compared between the two groups.Results VMCA and serum IMA reached the peak on days 7-10, followed by a gradual reduction. There were significant differences in VMCA and serum IMA across days 1-6, 7-10, and 11-14 (P<0.05). Compared with the non-DCI group, the DCI group had significantly higher incidence rate of CVS and serum IMA level (P<0.05). The poor prognosis group had a significantly higher serum IMA level than the good prognosis group (64.28±5.94 U/ml vs 45.46±5.72 U/ml, P<0.05).Conclusions Serum IMA level is closely associated with CVS and prognosis, and to a certain extent, it can reflect the severity of cerebral ischemia after aSAH. The evaluation of vasospasm-related DCI has an important value in prognosis prediction.