动脉瘤性蛛网膜下腔出血患者介入栓塞术后发生脑血管痉挛的影响因素分析  

Analysis of influencing factors of cerebral vasospasm after interventional embolization in patients with aneurysmal subarachnoid hemorrhage

作　　者：付建辉 周键 陈奇翰 徐良 FU Jianhui;ZHOU Jian;CHEN Qihan;XU Liang(Department of Neurosurgery,Tonglu First People's Hospital,Tonglu 311500,China;不详)

机构地区：[1]桐庐县第一人民医院神经外科,311500 [2]浙江大学医学院附属第二医院神经外科

出　　处：《心电与循环》2022年第2期169-172,178,共5页Journal of Electrocardiology and Circulation

摘　　要：目的 探讨动脉瘤性蛛网膜下腔出血(SAH)患者介入栓塞术后发生脑血管痉挛(CVS)的影响因素。方法 选取2019年10月至2021年9月在桐庐县第一人民医院行介入栓塞术的52例动脉瘤性SAH患者为研究对象,其中术后发生CVS 16例,未发生CVS 36例(痉挛程度为轻度4例、中度9例、重度3例)。分析动脉瘤性SAH患者术后发生CVS的影响因素,比较术后发生不同程度CVS患者血清缺氧诱导因子-2α(HIF-2α)、基质金属蛋白酶(MMP)-2、MMP-9、高迁移率族蛋白B1(HMGB1)及C反应蛋白(CRP)水平。结果 经单因素分析显示,动脉瘤性SAH患者术后发生CVS的患者血清HIF-2α、MMP-2、MMP-9、HMGB1、CRP水平均明显高于未发生CVS的患者(均P<0.05),但术后是否发生CVS与性别、年龄、发病至手术时间、Hunt-Hess分级、动脉瘤部位、合并高血压、吸烟等均无关(均P>0.05)。多因素logistic回归分析显示,HIF-2α(OR=1.978)、MMP-2(OR=2.512)、MMP-9(OR=1.779)、HMGB1(OR=2.232)、CRP(OR=1.958)均是动脉瘤性SAH患者术后发生CVS的独立影响因素(均P<0.05)。术后发生不同程度CVS患者血清HIF-2α、MMP-2、MMP-9、HMGB1及CRP水平比较,差异均有统计学意义(均P<0.05),其中重度组>中度组>轻度组(均P<0.05)。结论 血清HIF-2α、MMP-2、MMP-9、HMGB1、CRP水平升高是动脉瘤性SAH介入栓塞术后发生CVS的危险因素,且与CVS严重程度有关,应引起临床重视。Objective To investigate the influencing factors of cerebral vasospasm( CVS) after interventional embolization in patients with aneurysmal subarachnoid hemorrhage(aSAH). Methods A total of 52 a SAH patients undergoing interventional embolization at Tonglu First People’s Hospital from October 2019 to September 2021 were selected, among which, sixteen patients had postoperative occurrence of CVS(the degree of vessel spasticity: four cases were mild, nine cases were moderate, and three cases were severe), and 36 patients had no postoperative CVS.Influencing factors of postoperative CVS were analyzed in patients with a SAH. Serum hypoxia-inducible factor-2α(HIF-2α), matrix metalloproteinase(MMP)-2, MMP-9, high mobility group protein 1(HMGB1) and C-reactive protein(CRP) levels were compared among patients with different degrees of CVS. Results Univariate analysis showed that serum HIF-2α, MMP-2, MMP-9, HMGB1 and CRP levels were significantly higher in a SAH patients with postoperative CVS than those without(all P<0.05). However, the postoperative occurrence of CVS was not significantly related to gender,age, time from onset to operation, Hunt-Hess scale, location of aneurysm, hypertension and smoking(all P >0.05).Multivariate Logistic regression analysis showed that serum HIF-2α(OR=1.978), MMP-2(OR=2.512), MMP-9(OR= 1.779),HMGB1(OR=2.232) and CRP(OR=1.958) levels were the independent influencing factors of postoperative CVS in aSAH patients(all P<0.05). When serum HIF-2α, MMP-2, MMP-9, HMGB1 and CRP levels were compared among a SAH patients with different degrees of postoperative CVS, the differences were all statistically significant(all P<0.05), and their levels were compared in order of severity, severe group>moderate group > mild group(all P<0.05). Conclusion Elevated serum HIF-2α, MMP-2, MMP-9, HMGB1 and CRP levels are the risk factors of CVS after interventional embolization for aSAH and were tightly correlated with severity of CVS, which should be paid attention to.

关 键 词：动脉瘤性蛛网膜下腔出血 脑血管痉挛 缺氧诱导因子-2Α 基质金属蛋白酶 高迁移率族蛋白B1 C反应蛋白 

分 类 号：R743.35[医药卫生—神经病学与精神病学]