可溶性髓样细胞触发受体-1在动脉瘤性蛛网膜下腔出血后脑血管痉挛发生的临床意义  

Clinical significance of sTREM-1 in cerebral vasospasm after aneurysmal subarachnoid hemorrhage

作　　者：刘振龙 张雪峰[1,2] 时敬国 丛大伟 郎立峰[1] LIU Zhenlong;ZHANG Xuefeng;SHI Jingguo;CONG Dawei;LANG Lifeng(The Second School of Clinical Medicine,Binzhou Medical University,Yantai 264003,Shandong,P.R.China;Yantai Affiliated Hospital of Binzhou Medical University,Yantai 264100,Shandong,P.R.China)

机构地区：[1]滨州医学院第二临床医学院,山东烟台264003 [2]滨州医学院烟台附属医院,山东烟台264100

出　　处：《滨州医学院学报》2024年第5期321-325,共5页Journal of Binzhou Medical University

基　　金：山东省医药卫生科技项目(202304041087)。

摘　　要：目的 探究可溶性髓样细胞触发受体-1(sTREM-1)在动脉瘤性蛛网膜下腔出血患者脑脊液中的表达及其与脑血管痉挛发生的相关性,并确定其在评估脑血管痉挛严重程度中的诊断价值。方法 分析动脉瘤性蛛网膜下腔出血患者62例,记录其相关临床资料(年龄、性别、高血压病史、动脉瘤最大直径、手术方式、入院时Hutt-Hess分级和格拉斯哥评分、血小板计数、C反应蛋白、白细胞计数、低密度脂蛋白胆固醇(LDL-C)、血钠浓度、血钾浓度)。同时收集这些患者术后48 h内经腰穿或腰大池引流术动态采集的脑脊液标本,用酶联免疫吸附分析试剂盒测定患者脑脊液内sTREM-1浓度。以术后第5天动脉瘤性蛛网膜下腔出血患者行经颅多普勒测量的脑血管血液流速将患者分为血管痉挛轻微组和血管痉挛重症组。对上述临床相关资料与脑血管痉挛发生的严重程度进行多因素Logistic回归分析。对sTREM-1浓度和脑血管血流流速两者的测定结果进行相关性分析。结果 多因素Logistic回归分析结果显示:sTREM-1、入院时Hunt-Hess分级、高血压病史、白细胞计数、血钠浓度、血钾浓度为动脉瘤性蛛网膜下腔出血致脑血管痉挛严重程度的独立危险因素。动脉瘤性蛛网膜下腔出血患者脑脊液内sTREM-1浓度与MCA血流速度呈显著正相关(r=0.775,P=0.001)。结论 sTREM-1、入院时Hunt-Hess分级、高血压病史、白细胞计数、血钠浓度、血钾浓度是动脉瘤性蛛网膜下腔出血后脑血管痉挛发生的重要独立危险因素,sTREM-1可作为预测动脉瘤性蛛网膜下腔出血后脑血管痉挛发生和评估其严重程度的生物标志物。Objective To investigate the expression of soluble myeloid cell trigger receptor-1(sTREM-1)in cerebrospinal fluid of patients with aneurysmal subarachnoid hemorrhage(SAH)and its correlation with the occurrence of cerebral vasospasm,and to determine its diagnostic value in evaluating the severity of cerebral vasospasm.Methods Sixty-two patients with aneurysmal subarachnoid hemorrhage were analyzed,and the relevant clinical data(age,gender,history of hypertension,maximum aneurysm diameter,surgical method,Hutt-Hess grade and Glasgow score at admission,platelet count,C-reactive protein,white blood cell count,LDL-C,blood sodium concentration,and blood potassium concentration)were recorded.At the same time,cerebrospinal fluid samples dynamically collected by lumbar puncture or lumbar cisternectomy within 48 hours after surgery were collected,and sTREM-1 concentration in cerebrospinal fluid of these patients was measured with an enzyme-linked immunosorbent assay kit specially designed for humans.On the 5th day after the surgery,patients with aSAH were given transcranial Doppler(TCD)to evaluate the occurrence of cerebral vasospasm,and the changes of blood flow velocity were recorded.The patients were divided into the mild vasospasm group and the severe vasospasm group based on cerebral blood flow velocity.Multivariate Logistic regression analysis was performed on the above clinical relevant data and the severity of cerebrovascular spasm occurrence,and P<0.05 was considered to be statistically significant.Finally,the correlation between sTREM-1 concentration and cerebrovascular blood flow velocity was analyzed.Results Multivariate Logistic regression analysis showed that sTREM-1,Hunt-Hess grade at admission,hypertension history,white blood cell count,blood sodium concentration,and blood potassium concentration were independent risk factors for the severity of cerebral vasospasm caused by aneurysmal SAH.The concentration of sTREM-1 in cerebrospinal fluid of aSAH patients was significantly positively correlated with MCA blo

关 键 词：可溶性髓样细胞触发受体-1 脑血管痉挛 经颅多普勒超声 自发性蛛网膜下腔出血 动脉瘤破裂 

分 类 号：R651.1[医药卫生—外科学]