血清褪黑素在动脉瘤性蛛网膜下腔出血预后中的临床意义

doi:10.19854/j.cnki.1008-2425.2022.06.0002

立体定向和功能性神经外科杂志 ›› 2022, Vol. 35 ›› Issue (6): 326-331.DOI: 10.19854/j.cnki.1008-2425.2022.06.0002

血清褪黑素在动脉瘤性蛛网膜下腔出血预后中的临床意义

刘学武, 孙守元, 李富强, 戴志成

730900 白银甘肃中医药大学第三附属医院神经外科(刘学武,李富强,戴志成),兰州大学第二医院神经外科(孙守元)

收稿日期:2022-09-01 出版日期:2022-12-25 发布日期:2023-01-06
通讯作者: 戴志成 lxwabab123@163.com

Clinical significance of serum melatonin in the prognosis of aneurysmal subarachnoid hemorrhage

Liu Xuewu, Sun Shouyuan, Li Fuqiang, et al

1. Department of Neurosurgery,The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine,Baiyin Gansu 730900;
2. Department of Neurosurgery,The Second Hospital of Lanzhou University,JingyuanGansu,730030

Received:2022-09-01 Online:2022-12-25 Published:2023-01-06

摘要/Abstract

摘要： 目的分析血清褪黑素与动脉瘤性蛛网膜下腔出血(aSAH)短期功能预后的相关性。方法在2018年10月至2021年5月,连续纳入因单一颅内动脉瘤破裂而首次出现蛛网膜下腔出血的患者168例。主要研究结局是发病90 d时神经功能不良,其定义为改良Rankin评分(mRS)为4～6分;良好结局定义为mRS为1～3分。次要结局为发病30d的不良结局及主要并发症的发生率。入组后采集静脉血,采用酶联免疫吸附试验法检测血清褪黑素水平。结果根据mRS,将患者分为预后不良组(n=57)及预后良好组(n=111)。经Spearman分析,血清褪黑素水平与入院时世界神经外科医师联盟(WFNS)评分、Hunt&Hess分级、Fisher评分均呈显著正相关(r=0.442,0.476,0.239,P＜0.05)。预后不良组aSAH患者的血清褪黑素显著高于预后良好组[7.10(4.50,12.00)pg/ml vs.4.00(3.00,5.00)pg/mL,P＜0.001]。经受试者工作特征(ROC)曲线分析,血清褪黑素(0.790)预测aSAH发病后90d时预后不良的曲线下面积优于Hunt&Hess分级、Fisher评分(P＜0.05)。经多因素Logistics回归分析,血清褪黑素水平＞6.75 pg/mL为预测aSAH患者发病后90d时预后不良的独立危险因素(P＜0.001)。此外,血清褪黑素水平(0.785)对预测aSAH发病后30 d预后也有良好价值。且术后迟发性脑缺血(DCI)患者血清褪黑素水平高于无DCI患者(P＜0.001)。结论血清褪黑激素可能作为aSAH的一个有前景的预后生物标志物。

关键词: 褪黑素, 动脉瘤性蛛网膜下腔出血, 疾病严重程度, 预后

Abstract: Objective To analyze the correlation between serum melatonin and short-term functional prognosis of aneurysmal subarachnoid hemorrhage (aSAH).Methods From October 2018 to May 2021,168 patients with subarachnoid hemorrhage for the first time due to rupture of a single intracranial aneurysm were continuously included.The main outcome of the study was poor neurological function at 90 days after onset,which was defined as a modified Rankin score (mRS) of 4-6;Good outcome was defined as mRS of 1-3.The secondary outcomes were the adverse outcomes and the incidence of major complications after 30 days of onset.Venous blood was collected after enrollment,and serum melatonin level was detected by enzyme-linked immunosorbent assay.Results According to mRS,the patients were divided into poor prognosis group (n=57) and good prognosis group (n=111).By Spearman analysis,the serum melatonin level was significantly positively correlated with the World Federation of neurosurgeons (WFNS) score,Hunt & Hess score and Fisher score at admission (r=0.442,0.476,0.239,P＜0.05).The serum melatonin of aSAH patients in poor prognosis group was significantly higher than that in good prognosis group [7.10 (4.50,12.00) pg/ml vs.4.00 (3.00,5.00) pg/ml,P＜0.001].According to the ROC curve analysis,the area under the curve of serum melatonin (0.790) to predict the poor prognosis at 90 days after the onset of aSAH was better than Hunt & Hess grade and Fisher score (P＜0.05).By multivariate logistic regression analysis,serum melatonin＞6.75 pg/ml was an independent risk factor for predicting poor prognosis of aSAH patients 90 days after onset (P＜0.001).In addition,the serum melatonin level (0.785) also has a good value in predicting the prognosis of aSAH 30 days after onset.The serum melatonin level in patients with delayed cerebral ischemia (DCI) was higher than that in patients without DCI (P＜0.001).Conclusion Serum melatonin may serve as a promising prognostic biomarker for aSAH.

Key words: Melatonin, Aneurysmal subarachnoid hemorrhage, Disease severity, Prognosis

中图分类号:

R732.2⁺1

刘学武, 孙守元, 李富强, 戴志成. 血清褪黑素在动脉瘤性蛛网膜下腔出血预后中的临床意义[J]. 立体定向和功能性神经外科杂志, 2022, 35(6): 326-331.

Liu Xuewu, Sun Shouyuan, Li Fuqiang, et al. Clinical significance of serum melatonin in the prognosis of aneurysmal subarachnoid hemorrhage[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2022, 35(6): 326-331.

参考文献

[1] Luo YG,Han B,Sun TW,et al.The association between serum adipocyte fatty acid-binding protein and 3-month disability outcome after aneurysmal subarachnoid hemorrhage[J].J Neuroinflammation,2020,17(1):66.
[2] 秦浩,尹航,张亚波,等.血浆IGF-1联合GOS评分对动脉瘤性蛛网膜下腔出血患者预后的预测价值[J].山东医药,2020,60(31):60~63.
[3] Bsat S,Chanbour H,Alomari S,et al.Can we improve the prediction of complications and outcome in aneurysmal subarachnoid hemorrhage? The clinical implications of serum proteomics[J].J Integr Neurosci,2020,19(4):711~717.
[4] Shukla M,Govitrapong P,Boontem P,et al.Mechanisms of Melatonin in Alleviating Alzheimer's Disease[J].Curr Neuropharmacol,2017,15(7):1010~1031.
[5] 周阳,米旭光,蒲文星,等.褪黑素对过氧化氢诱导人神经母细胞瘤SH-SY5Y细胞氧化应激的改善作用及其机制[J].吉林大学学报(医学版),2022,48(2):340~347.
[6] Guo ZN,Jin H,Sun H,et al.Antioxidant Melatonin:Potential Functions in Improving Cerebral Autoregulation After Subarachnoid Hemorrhage[J].Front Physiol,2018,9:1146.
[7] McMillan T,Wilson L,Ponsford J,et al.The Glasgow Outcome Scale - 40 years of application and refinement[J].Nat Rev Neurol,2016,12(8):477~485.
[8] Lai X,Zhang W,Ye M,et al.Development and validation of a predictive model for the prognosis in aneurysmal subarachnoid hemorrhage[J].J Clin Lab Anal,2020,34(12):e23542.
[9] 康文慧,陈仪婷,赵安达,等.褪黑素在哮喘发病和病程中的作用机制研究进展[J].上海交通大学学报(医学版),2022,42(5):667~672.
[10] Chitimus DM,Popescu MR,Voiculescu SE,et al.Melatonin's Impact on Antioxidative and Anti-Inflammatory Reprogramming in Homeostasis and Disease[J].Biomolecules,2020,10(9):1211.
[11] Lorente L,Martín M.M,Abreu-González P,et al.Serum melatonin levels are associated with mortality in patients with malignant middle cerebral artery infarction[J].J.Int.Med.Res,2018,46:3268~3277.
[12] 王琮民,闫纪琳,李海涛,等.褪黑素腹腔注射对急性脑梗死大鼠神经细胞损伤凋亡的改善作用及其机制[J].山东医药,2022,62(9):6~11.
[13] Hu X,Zhu Y,Zhou F,et al.Efficacy of Melatonin in Animal Models of Subarachnoid Hemorrhage:A Systematic Review and Stratified Meta-Analysis[J].Front Neurol,2021,12:685731.
[14] Lin F,Li R,Tu WJ,et al.An Update on Antioxidative Stress Therapy Research for Early Brain Injury After Subarachnoid Hemorrhage[J].Front Aging Neurosci,2021,13:772036.
[15] 肖刚,罗超,彭形,等.甘草甜素通过抑制炎症反应和氧化应激改善大鼠蛛网膜下腔出血后血脑屏障损伤[J].中国免疫学杂志,2019,35(7):811~818.
[16] Zhan CP,Zhuge CJ,Yan XJ,et al.Measuring serum melatonin concentrations to predict clinical outcome after aneurysmal subarachnoid hemorrhage[J].Clin Chim Acta,2021,513:1~5.

血清褪黑素在动脉瘤性蛛网膜下腔出血预后中的临床意义

Clinical significance of serum melatonin in the prognosis of aneurysmal subarachnoid hemorrhage

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 7

编辑推荐

Metrics

本文评价

[1]	陈锋龙, 陈金龙, 张弋. 75岁以上人群破裂颅内动脉瘤栓塞术后早期预后相关因素分析[J]. 立体定向和功能性神经外科杂志, 2022, 35(6): 321-325.
[2]	杜云, 王卫中, 刘梦, 姚萌萌. Notch3与TIP30表达对脑胶质瘤患者预后评估价值[J]. 立体定向和功能性神经外科杂志, 2022, 35(5): 273-279.
[3]	张睿，齐戈尧，阿迪莱·阿卜杜热西提，程岗，张剑宁. 原发中枢神经系统淋巴瘤的预后因素分析[J]. 立体定向和功能性神经外科杂志, 2022, 35(4): 198-204.
[4]	梁喜安, 黄永旺, 韦述志, 周元贵, 韦晗, 梁意能. 无牵拉经侧裂岛叶入路显微镜手术治疗老年高血压基底节区脑出血的效果研究[J]. 立体定向和功能性神经外科杂志, 2022, 35(4): 210-215.
[5]	韩世文，洪文明，宣浩. 85例脑膜瘤患者术后临床结局和复发情况及其影响因素的分析[J]. 立体定向和功能性神经外科杂志, 2022, 35(4): 221-225.
[6]	叶成坤, 徐奔, 牛朝诗. 老年胶质瘤的影像学及分子病理学分析[J]. 立体定向和功能性神经外科杂志, 2022, 35(2): 71-74.
[7]	王志丹, 依斯哈尔巴拉提, 阿卜力克木·伊敏江, 迪里夏提·依马木, 巴高. IL-37在不同级别胶质瘤组织中的表达及其与预后的相关性[J]. 立体定向和功能性神经外科杂志, 2021, 34(6): 353-357.