炎性指标在动脉瘤性蛛网膜下腔出血预后中的研究进展

doi:10.3760/cma.j.issn.1007-1245.2022.22.032

摘要/Abstract

摘要： 动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage，aSAH）是临床常见的脑血管疾病，也是神经外科领域一种致死、致残率都极高的急危重症。目前人们对其病因，即颅内动脉瘤的处理已取得长足进步，再出血发生率大大降低，但仍有很大一部分aSAH患者预后较差。其中，引起早期脑损伤的神经炎性反应可能是导致不良预后的关键因素。目前已有研究报道了与aSAH预后有关的炎性指标，并在临床得以应用，本文就这些指标的国内外研究进展进行综述。

关键词: 动脉瘤性蛛网膜下腔出血, 炎性指标, 预后

Abstract: Aneurysmal subarachnoid hemorrhage (aSAH) is a common clinical cerebrovascular disease and a critical emergency in the field of neurosurgery with a high mortality and a disability rate. Considerable progress has been made in the management of its cause, namely intracranial aneurysms, and the incidence of re-bleeding has been greatly reduced, but a large proportion of patients with aSAH still have poor prognosis. Among these, the neuroinflammatory response that causes early brain injury may be a key factor for poor prognosis. Inflammatory indicators related to the prognosis of aSAH have been reported and used in clinical practice, and this article reviews the progress of domestic and international studies on these indicators.

Key words: Aneurysmal subarachnoid hemorrhage, Inflammatory indicators, Prognosis

彭晖陈伟强. 炎性指标在动脉瘤性蛛网膜下腔出血预后中的研究进展[J]. 国际医药卫生导报, 2022, 28(22): 3252-3256.

Peng Hui, Chen Weiqiang. Research progress of inflammatory indicators in the prognosis of aneurysmal subarachnoid hemorrhage[J]. International Medicine and Health Guidance News, 2022, 28(22): 3252-3256.

参考文献

[1] Ingall T, Asplund K, Mähönen M, et al. A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study[J]. Stroke, 2000, 31(5):1054-1061. DOI: 10.1161/01.str.31.5.1054.
[2] Pradilla G, Wang PP, Legnani FG, et al. Prevention of vasospasm by anti-CD11/CD18 monoclonal antibody therapy following subarachnoid hemorrhage in rabbits[J]. J Neurosurg, 2004, 101(1):88-92. DOI: 10.3171/jns.2004.101.1.0088.
[3] 卢子明.炎症反应在动脉瘤性蛛网膜下腔出血早期脑损伤的作用及治疗进展[J].中国微侵袭神经外科杂志,2020,25(2):91-93. DOI:10.11850/j.issn.1009- 122X.2020.02.013.
[4] Dumont AS, Dumont RJ, Chow MM, et al. Cerebral vasospasm after subarachnoid hemorrhage: putative role of inflammation[J]. Neurosurgery, 2003, 53(1):123-133; discussion 133-135. DOI: 10.1227/01.neu.0000068863.37133.9e.
[5] 滕秋玉.银杏叶提取物联合依达拉奉治疗急性脑出血患者疗效观察及对炎症因子的影响[J].国际医药卫生导报,2020,26(19):2935-2938. DOI:10.3760/cma.j.issn.1007-1245.2020.19.031.
[6] 黄毓华.布洛芬治疗蛛网膜下腔出血后迟发性脑血管痉挛(DCVS)的疗效观察[J].临床和实验医学杂志,2007,6(5):94-95. DOI:10.3969/j.issn.1671-4695.2007.05.054.
[7] Simard JM, Geng Z, Woo SK, et al. Glibenclamide reduces inflammation, vasogenic edema, and caspase-3 activation after subarachnoid hemorrhage[J]. J Cereb Blood Flow Metab, 2009, 29(2):317-330. DOI: 10.1038/jcbfm.2008.120.
[8] Frontera JA, Provencio JJ, Sehba FA, et al. The role of platelet activation and inflammation in early brain injury following subarachnoid hemorrhage[J]. Neurocrit Care, 2017, 26(1):48-57. DOI: 10.1007/s12028-016-0292-4.
[9] von der Brelie C, Subai A, Limperger V, et al. In vitro analysis of platelet function in acute aneurysmal subarachnoid haemorrhage[J]. Neurosurg Rev, 2018, 41(2):531-538. DOI: 10.1007/s10143-017-0885-1.
[10] Baranich AI, Savin IA, Tabasaranskiy TF, et al. Disturbances of the hemostatic system in patients with aneurysmal subarachnoid hemorrhage[J]. Zh Vopr Neirokhir Im N N Burdenko, 2018, 82(4):109-116.
[11] Ghali MGZ, Srinivasan VM, Johnson J, et al. Therapeutically targeting platelet-derived growth factor-mediated signaling underlying the pathogenesis of subarachnoid hemorrhage-related vasospasm[J]. J Stroke Cerebrovasc Dis, 2018, 27(9):2289-2295. DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.017.
[12] Chen L, Zhang Q. Increased mean platelet volume is associated with poor outcome in patients with aneurysmal subarachnoid hemorrhage[J]. World Neurosurg, 2020, 137:e118-e125. DOI: 10.1016/j.wneu.2020.01.068.
[13] 赵龙,陈志力,王京,等.早期血小板参数对动脉瘤蛛网膜下腔出血后迟发性脑缺血的评估意义[J].中华实验外科杂志,2022,39(3):586. DOI:10.3760/cma.j.cn421213- 20200601-00404.
[14] Mahta A, Azher AI, Moody S, et al. Association of early white blood cell trend with outcomes in aneurysmal subarachnoid hemorrhage[J]. World Neurosurg, 2021, 151:e803-e809. DOI: 10.1016/j.wneu.2021.04.124.
[15] Al-Mufti F, Misiolek KA, Roh D, et al. White blood cell count improves prediction of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage[J]. Neurosurgery, 2019, 84(2):397-403. DOI: 10.1093/neuros/nyy045.
[16] Hu P, Yang X, Li Y, et al. Predictive effects of admission white blood cell counts and hounsfield unit values on delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage[J]. Clin Neurol Neurosurg, 2022, 212:107087. DOI: 10.1016/j.clineuro.2021.107087.
[17] Chung J, Bae J, Kwon Y, et al. Neutrophil/lymphocyte ratio in patients undergoing noncardiac surgery after coronary stent implantation[J]. J Cardiothorac Vasc Anesth, 2020, 34(6):1516-1525. DOI: 10.1053/j.jvca.2019.10.009.
[18] Al-Mufti F, Amuluru K, Damodara N, et al. Admission neutrophil-lymphocyte ratio predicts delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage[J]. J Neurointerv Surg, 2019, 11(11):1135-1140. DOI: 10.1136/neurintsurg-2019-014759.
[19] Chen H, Li M, Liu L, et al. Monocyte/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients with non-ST-elevation myocardial infarction[J]. Medicine (Baltimore), 2019, 98(26):e16267. DOI: 10.1097/MD.0000000000016267.
[20] 贾传宇,王舒阳,刘莉莉,等.早期外周血系统性炎症指标在动脉瘤性蛛网膜下腔出血不良预后中的预测价值[J].中国临床神经科学,2020,28(6):682-686.
[21] Silvestrin V, Bonvini S, Antonello M, et al. Systemic inflammatory response and severe thrombocytopenia after endovascular thoracic aortic aneurysm repair[J]. Case Rep Med, 2017, 2017:3018919. DOI: 10.1155/2017/3018919.
[22] 王冠宇,孙宇强,谭泽士,等.107例动脉瘤性蛛网膜下腔出血患者预后的多因素分析[J].临床神经外科杂志,2016,13(2):136-140. DOI:10.3969/j.issn.1672-7770.2016.02.015.
[23] Hirashima Y, Endo S, Ohmori T, et al. Platelet-activating factor (PAF) concentration and PAF acetylhydrolase activity in cerebrospinal fluid of patients with subarachnoid hemorrhage[J]. J Neurosurg, 1994, 80(1):31-36. DOI: 10.3171/jns.1994.80.1.0031.
[24] 王帅,王政刚.血小板活化因子与蛛网膜下腔出血后脑血管痉挛[J].国外医学(生理、病理科学与临床分册),2001,21(5):366-367. DOI:10.3969/j.issn.1673-2588.2001. 05.016.
[25] Hirashima Y, Endo S, Nukui H, et al. Effect of a platelet-activating factor receptor antagonist, E5880, on cerebral vasospasm after aneurysmal subarachnoid hemorrhage--open clinical trial to investigate efficacy and safety[J]. Neurol Med Chir (Tokyo), 2001, 41(4):165-175; discussion 175-176. DOI: 10.2176/nmc.41.165.
[26] Varasteh-Ravan HR, Ali-Hasan-Al-Saegh S, Shokraneh S, et al. Relationship of admission mean platelet volume, platelet distribution width and white blood cells with ST resolution in patients with acute ST segment elevation myocardial infarction treated with streptokinase without history of previous cardiovascular surgery[J]. Perspect Clin Res, 2013, 4(2):125-129. DOI: 10.4103/2229-3485. 111792.
[27] Ray B, Tinsley L, Ford L, et al. Trends of platelet volume index predicts delayed cerebral ischemia after subarachnoid hemorrhage[J]. World Neurosurg, 2018, 111:e624-e631. DOI: 10.1016/j.wneu.2017.12.131.
[28] Azab B, Torbey E, Singh J, et al. Mean platelet volume/platelet count ratio as a predictor of long-term mortality after non-ST-elevation myocardial infarction[J]. Platelets, 2011, 22(8):557-566. DOI: 10.3109/09537104.2011. 584086.
[29] Oh GH, Chung SP, Park YS, et al. Mean platelet volume to platelet count ratio as a promising predictor of early mortality in severe sepsis[J]. Shock, 2017, 47(3):323-330. DOI: 10.1097/SHK.0000000000000718.
[30] 康平,苏龙,李健,等.血小板体积指数预测动脉瘤性蛛网膜下腔出血后迟发性脑缺血的价值[J].心脑血管病防治,2019,19(6):573-575,591. DOI:10.3969/j.issn.1009_816x.2019.06.029.
[31] 陈陶. 动脉瘤蛛网膜下腔出血后血小板参数与迟发性脑缺血及预后的相关性研究[D]. 南充:川北医学院,2020. DOI:10.27755/d.cnki.gcbyx.2020.000064.
[32] 杨敬,华琦,徐东,等.高敏C反应蛋白在急性冠脉综合征中的临床意义[J].首都医科大学学报,2009,30(4):556-559. DOI:10.3969/j.issn.1006-7795.2009.04.032.
[33] Danesh J, Wheeler JG, Hirschfield GM, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease[J]. N Engl J Med, 2004, 350(14):1387-1397. DOI: 10.1056/NEJMoa032804.
[34] Di Napoli M, Di Gianfilippo G, Sollecito A, et al. C-reactive protein and outcome after first-ever ischemic stroke[J]. Stroke, 2000, 31(1):238-239. DOI: 10.1161/01.str.31. 1.231-f.
[35] 郭毅,姜昕,陈实,等.C反应蛋白--缺血性脑卒中预后的重要标志物[J].中华预防医学杂志,2003,37(2):102-104. DOI:10.3760/j:issn:0253-9624.2003.02.009.
[36] 阮东,王芳,郭丽蕊,等.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,2017,22(9):626-629. DOI:10.13798/j.issn.1009- 153X.2017.09.006.
[37] Turner CL, Budohoski K, Smith C, et al. Elevated baseline C-reactive protein as a predictor of outcome after aneurysmal subarachnoid hemorrhage: data from the simvastatin in aneurysmal subarachnoid hemorrhage (STASH) trial[J]. Neurosurgery, 2015, 77(5):786-792; discussion 792-793. DOI: 10.1227/NEU.0000000000000963.
[38] Zhang D, Yan H, Wei Y, et al. C-reactive protein/albumin ratio correlates with disease severity and predicts outcome in patients with aneurysmal subarachnoid hemorrhage[J]. Front Neurol, 2019, 10:1186. DOI: 10.3389/fneur.2019.01186.
[39] 符传铰,夏鹰,陈华澎.外周血白细胞计数、C反应蛋白/白蛋白比值与动脉瘤性蛛网膜下腔出血患者短期预后相关性研究[J].创伤与急危重病医学,2021,9(2):101-104. DOI:10.16048/j.issn.2095-5561.2021.02.05.
[40] Srinivasan A, Aggarwal A, Gaudihalli S, et al. Impact of early leukocytosis and elevated high-sensitivity C-reactive protein on delayed cerebral ischemia and neurologic outcome after subarachnoid hemorrhage[J]. World Neurosurg, 2016, 90:91-95. DOI: 10.1016/j.wneu.2016.02.049.
[41] Luo C, Yao J, Bi H, et al. Clinical value of inflammatory cytokines in patients with aneurysmal subarachnoid hemorrhage[J]. Clin Interv Aging, 2022, 17:615-626. DOI: 10.2147/CIA.S362854.
[42] Niwa A, Osuka K, Nakura T, et al. Interleukin-6, MCP-1, IP-10, and MIG are sequentially expressed in cerebrospinal fluid after subarachnoid hemorrhage[J]. J Neuroinflammation, 2016, 13(1):217. DOI: 10.1186/s12974-016-0675-7.
[43] 张纪庆,王志刚,冀勇,等.动脉瘤性蛛网膜下腔出血患者血液NF-κB与sICAM-1含量变化的临床意义[J].中国老年学杂志,2007,27(12):1174-1176. DOI:10.3969/j.issn.1005- 9202.2007.12.025.
[44] Jayaraman T, Berenstein V, Li X, et al. Tumor necrosis factor alpha is a key modulator of inflammation in cerebral aneurysms[J]. Neurosurgery, 2005, 57(3):558-564; discussion 558-564. DOI: 10.1227/01.neu.0000170439.89041.d6.
[45] 韩磊,王志刚,曲春城,等.破裂颅内动脉瘤瘤壁核因子κB与血管内皮生长因子的表达[J].中国神经精神疾病杂志,2008(2):91-94.
[46] Zheng S, Su A, Sun H, et al. The association between interleukin-6 gene polymorphisms and intracranial aneurysms: a meta-analysis[J]. Hum Immunol, 2013, 74(12):1679-1683. DOI: 10.1016/j.humimm.2013.08.274.
[47] You W, Zuo G, Shen H, et al. Potential dual role of nuclear factor-kappa B in experimental subarachnoid hemorrhage-induced early brain injury in rabbits[J]. Inflamm Res, 2016, 65(12):975-984. DOI: 10.1007/s00011-016-0980-8.
[48] 刘颖,刘业松,李聪慧,等.蛛网膜下腔出血后迟发性脑血管痉挛中 TNF-α和NF-кB 的表达变化[J].河北医药,2014,(13):1934-1936. DOI:10.3969/j.issn.1002-7386.2014. 31.004.
[49] 张秋建,王大巍,束汉生.触珠蛋白(Hp2-2)和肿瘤坏死因子(TNF-α)在颅内动脉瘤破裂伴蛛网膜下腔出血的临床价值研究[J].齐齐哈尔医学院学报,2019,40(19):2384-2386. DOI:10.3969/j.issn.1002-1256.2019.19.003.
[50] Vlachogiannis P, Hillered L, Khalil F, et al. Interleukin-6 levels in cerebrospinal fluid and plasma in patients with severe spontaneous subarachnoid hemorrhage[J]. World Neurosurg, 2019, 122:e612-e618. DOI: 10.1016/j.wneu.2018.10.113.
[51] Chaudhry SR, Stoffel-Wagner B, Kinfe TM, et al. Elevated systemic IL-6 levels in patients with aneurysmal subarachnoid hemorrhage is an unspecific marker for post-SAH complications[J]. Int J Mol Sci, 2017, 18(12):2580. DOI: 10.3390/ijms18122580.
[52] Ahn SH, Savarraj JPJ, Parsha K, et al. Inflammation in delayed ischemia and functional outcomes after subarachnoid hemorrhage[J]. J Neuroinflammation, 2019, 16(1):213. DOI: 10.1186/s12974-019-1578-1.
[53] Schoch B, Regel JP, Wichert M, et al. Analysis of intrathecal interleukin-6 as a potential predictive factor for vasospasm in subarachnoid hemorrhage[J]. Neurosurgery, 2007, 60(5):828-836; discussion 828-836. DOI: 10.1227/01.NEU.0000255440.21495.80.
[54] Matsumoto J, Dohgu S, Takata F, et al. TNF-α-sensitive brain pericytes activate microglia by releasing IL-6 through cooperation between IκB-NFκB and JAK-STAT3 pathways[J]. Brain Res, 2018, 1692:34-44. DOI: 10.1016/j.brainres.2018.04.023.
[55] 吕洲,刘青蕊.NF-κB、TNF-α在动脉瘤性蛛网膜下腔出血患者中的表达及对介入预后的预测作用[J].武警后勤学院学报(医学版),2021,30(7):1-6. DOI:10.16548/j.2095-3720.2021.07.018.
[56] 梁汉才,杨福义.核转录因子-κB和肿瘤坏死因子-α在动脉瘤性蛛网膜下腔出血患者血清中的表达[J/CD].中西医结合心血管病电子杂志,2015,3(33):49-50. DOI:10.16282/j.cnki.cn11-9336/r.2015.33.031.