Preventive effects of cilostazol against the development of shunt-dependent hydrocephalus after subarachnoid hemorrhage
Preventive effects of cilostazol against the development of shunt-dependent hydrocephalus after subarachnoid hemorrhage
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DOI：
10.3171/2016.5.jns152907
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发表时间：
2017-08-01
影响因子：
4.1
通讯作者：
Suzuki, Hidenori
中科院分区：
文献类型：
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作者：
Nakatsuka, Yoshinari;Kawakita, Fumihiro;Suzuki, Hidenori
目的：蛛网膜下腔出血（SAH）后，细胞内基质蛋白生腱蛋白C（TNC）的诱导与慢性脑积水的发生有关。本研究的目的是研究西洛他唑，磷酸二酯酶III型的选择性抑制剂，抑制TNC诱导在SAH patients.METHODS的作者回顾性分析了影响因素的发展慢性分流依赖性脑积水87例Fisher 3级SAH采用多因素Logistic回归分析。根据主治神经外科医生的偏好，从动脉瘤闭塞后第二天开始给予西洛他唑（50或100 mg，每日给药2或3次）。作为一项单独的研究，观察了不同剂量西洛他唑对38例SAH患者血清TNC水平的影响，从第1天到第12天。0 mg/d、100 - 200 mg/d和300 mg/d西洛他唑组分别有5/39例（12.8%）和1/12例（8.3%）患者发生了上述事件。多变量分析显示，（OR 1.10，95% CI 1.13-1.24; p = 0.012），急性脑积水（OR 23.28，95% CI 1.75-729.83; p = 0.016）和西洛他唑（OR 0.23，95% CI 0.05-0.93; p = 0.038）独立影响慢性脑积水的发生。更高剂量的西洛他唑更有效地抑制血清TNC水平，通过第1天至12天后SAH.CONCLUSIONS西洛他唑可以防止慢性脑积水的发展，减少分流手术，可能通过抑制TNC诱导后SAH。
OBJECTIVE Chronic hydrocephalus develops in association with the induction of tenascin-C (TNC), a matricellular protein, afteraneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to examine if cilostazol, a selective inhibitor of phosphodiesterase Type III, suppresses the development of chronic hydrocephalus by inhibiting TNC induction in aneurysmal SAH patients.METHODS The authors retrospectively reviewed the factors influencing the development of chronic shunt-dependent hydrocephalus in 87 patients with Fisher Grade 3 SAH using multivariate logistic regression analyses. Cilostazol (50 or 100 mg administered 2 or 3 times per day) was administered from the day following aneurysmal obliteration according to the preference of the attending neurosurgeon. As a separate study, the effects of different dosages of cilostazol on the serum TNC levels were chronologically examined from Days 1 to 12 in 38 SAH patients with Fisher Grade 3 SAH.RESULTS Chronic hydrocephalus occurred in 12 of 36 (33.3%), 5 of 39 (12.8%), and 1 of 12 (8.3%) patients in the 0 mg/day, 100 to 200 mg/day, and 300 mg/day cilostazol groups, respectively. The multivariate analyses showed that older age (OR 1.10, 95% CI 1.13-1.24; p = 0.012), acute hydrocephalus (OR 23.28, 95% CI 1.75-729.83; p = 0.016), and cilostazol (OR 0.23, 95% CI 0.05-0.93; p = 0.038) independently affected the development of chronic hydrocephalus. Higher dosages of cilostazol more effectively suppressed the serum TNC levels through Days 1 to 12 post-SAH.CONCLUSIONS Cilostazol may prevent the development of chronic hydrocephalus and reduce shunt surgery, possibly by the inhibition of TNC induction after SAH.