血清肌钙蛋白I预测血管内弹簧圈栓塞治疗动脉瘤性蛛网膜下腔出血患者转归  

Serum cardiac troponin I predicts the outcome of patients with aneurismal subarachnoid hemorrhage treated with endovascular coil embolization

作　　者：陈艳[1] 吴迪[2] 程琼[3] 李永坤[3] 汪银洲[3] 郑峥[3] Chen Yan;Wu Di;Cheng Qiong;Li Yongkun;Wang Yinzhou;Zheng Zheng(Department of Geriatrics,Fujian Provincial Hospital,Provincial School of Clinical Medicine,Fujian Medical University,Fuzhou 350001,China;Sino-American Neuroscience Institute,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Neurology,Fujian Provincial Hospital,Provincial School of Clinical Medicine,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院老年科,福州350001 [2]首都医科大学宣武医院,中美神经科学研究所,北京100053 [3]福建医科大学省立临床医学院,福建省立医院神经内科,福州350001

出　　处：《国际脑血管病杂志》2020年第9期680-686,共7页International Journal of Cerebrovascular Diseases

基　　金：福建省自然科学基金卫生联合面上项目(2017J01240,2017J01176);福建省卫生健康中青年骨干人才培养项目(2019-ZQN-3)。

摘　　要：目的:探讨血清肌钙蛋白I(cardiac troponin I,cTnI)水平对动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者血管内弹簧圈栓塞治疗后临床转归的预测价值。方法:回顾性纳入2017年1月至2019年12月在福建省立医院神经内科接受血管内弹簧圈栓塞治疗的aSAH患者。收集患者基线资料、临床分级、血清cTnI及N末端B型利钠肽原(N-terminal pro B-type natriuretic peptide,NT-proBNP)水平、心电图、动脉瘤特征、血管内治疗情况以及并发症等信息。在患者发病后90 d采用改良Rankin量表(modified Rankin Scale,mRS)进行转归评价,转归不良定义为>2分。应用多变量logistic回归分析确定转归不良的独立危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线评价血清cTnI水平对转归不良的预测价值。结果:共纳入316例患者,其中256例转归良好(81.01%),60例转归不良(18.99%),13例(4.11%)死亡。47例(14.87%)患者血清cTnI水平升高,转归不良组血清cTnI水平升高的患者比例显著高于转归良好组(45%对7.81%;P<0.001)。与转归良好组比较,转归不良组格拉斯哥昏迷量表评分更低,Hunt-Hess分级和Fisher分级更高(P均<0.001)。转归不良组NT-proBNP水平升高及心电图异常的患者构成比(P均<0.001)亦显著高于转归良好组。转归不良组接受支架辅助弹簧圈栓塞、脑脊液置换和脑室外引流的比例以及并发脑梗死、脑积水、癫痫发作和再出血的发生率均显著高于转归良好组(P均<0.01)。多变量logistic回归分析显示,在校正其他混杂因素后,Hunt-Hess分组3~5级[优势比(odds ratio,OR)6.615,95%可信区间(confidence interval,CI)2.158~20.278;P=0.001]、Fisher分级3~4级(OR 3.719,95%CI 1.479~9.352;P=0.005)、脑梗死(OR 15.814,95%CI 4.978~50.235;P<0.001)、再出血(OR 13.324,95%CI 2.092~84.881,P=0.006)以及血清cTnI水平升高(OR 3.874,95%CI 1.406~10.672;P=0.009)与转归不良显著独立相关,可独立预测aSAH�Objective To investigate the predicting value of cardiac serum troponin I(cTnI)levels for the clinical outcome of patients with aneurismal subarachnoid hemorrhage(aSAH)after endovascular coil embolization.Methods Patients with aSAH treated with endovascular coil embolization in the Department of Neurology,Fujian Provincial Hospital from January 2017 to December 2019 were enrolled retrospectively.The baseline data,clinical grade,serum cTnI and N-terminal-pro B-type natriuretic peptide(NT-proBNP)levels,electrocardiogram,aneurysm characteristics,endovascular treatment status,and complications of the patents were collected.The outcomes were evaluated by the modified Rankin Scale(mRS)at 90 d after onset.Poor outcome was defined as>2 points.Multivariate logistic regression analysis was used to identify the independent risk factors for poor outcomes.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum cTnI levels for poor outcomes.Results A total of 316 patients were enrolled,among them,256 had good outcomes(81.01%),60 had poor outcomes(18.99%)and 13 died(4.11%).Forty-seven patients(14.87%)had elevated serum cTnI levels.The proportion of patients with elevated serum cTnI levels in the poor outcome group was significantly higher than that in the good outcome group(45%vs.7.81%;P<0.001).Compared with the good outcome group,the Glasgow Coma Scale score of the poor outcome group was lower,and the Hunt-Hess grades and Fisher grades were higher(P<0.001).The proportion of patients with elevated NT-proBNP levels and abnormal electrocardiogram in the poor outcome group(all P<0.001)were also significantly higher than those in the good outcome group.The proportion of receiving stent-assisted coil embolization,cerebrospinal fluid replacement and ventricular drainage,as well as the incidence of complicated with cerebral infarction,hydrocephalus,seizure and rebleeding in the poor outcome group were significantly higher than those in the good outcome group(all P<0.01).Multivariate logistic regr

关 键 词：蛛网膜下腔出血 颅内动脉瘤 动脉瘤 破裂 栓塞 治疗性 肌钙蛋白I 生物标志物 治疗结果 

分 类 号：R743.35[医药卫生—神经病学与精神病学]