Increased cerebrospinal fluid concentrations of asymmetric dimethylarginine correlate with adverse clinical outcome in subarachnoid hemorrhage patients
Increased cerebrospinal fluid concentrations of asymmetric dimethylarginine correlate with adverse clinical outcome in subarachnoid hemorrhage patients
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脑脊液中不对称二甲基精氨酸浓度增加与蛛网膜下腔出血患者的不良临床结果相关
DOI：
10.1016/j.jocn.2013.11.038
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发表时间：
2014-08-01
影响因子：
2
通讯作者：
Hang, Chun-Hua
中科院分区：
文献类型：
--
作者：
Li, Hua;Wu, Wei;Hang, Chun-Hua
在蛛网膜下腔出血（SAH）患者的脑脊液（CSF）中发现了不对称二甲基精氨酸（ADMA）（一种内源性一氧化氮合酶抑制剂）浓度升高。此外，CSF中ADMA水平与血管痉挛的严重程度相关。然而，CSF ADMA水平与SAH患者临床结局之间的关系仍不清楚。我们推测脑脊液中ADMA水平升高可能与SAH患者的临床结局有关。采用高效液相色谱法测定20例SAH患者SAH发作后第3-5天、第7-9天和第12-14天脑脊液ADMA水平。经颅多普勒超声评估脑血管痉挛。使用Karnofsky体能状态量表（KPS）评价2年随访时的临床结局。所有SAH患者的CSF ADMA浓度在SAH后第3-5天显著增加（p = 0.002），在第7-9天达到峰值（p < 0.001），并保持升高直到第12-14天（p < 0.001）。在亚组分析中，在有和没有血管痉挛的患者中发现CSF ADMA水平显著增加。KPS评分与第7-9天的CSF ADMA水平显著相关（相关系数=-0.55，p = 0.012; 95%置信区间-0.80至-0.14）。二元逻辑回归分析表明，在SAH后第7-9天较高的ADMA水平预测在2年随访时较差的临床结局（比值比= 1.722，p = 0.039，95%置信区间1.029至2.882）。ADMA可能直接参与SAH的病理过程和不良预后。(C)2014爱思唯尔有限公司版权所有。
Elevated cerebrospinal fluid (CSF) concentrations of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, have been found in patients with subarachnoid hemorrhage (SAH). In addition, CSF levels of ADMA are associated with the severity of vasospasm. However, the relation between CSF ADMA levels and the clinical outcome of SAH patients is still unclear. We hypothesized that elevated ADMA levels in CSF might be related to the clinical outcome of SAH patients. CSF ADMA levels were measured in 20 SAH patients at days 3-5, days 7-9 and days 12-14 after SAH onset using high-performance liquid chromatography. Cerebral vasospasm was assessed by transcranial Doppler ultra sonography. Clinical outcome at 2 year follow-up was evaluated using the Karnofsky Performance Status scale (KPS). CSF ADMA concentrations in all SAH patients were significantly increased at days 3-5 (p = 0.002) after SAH, peaked on days 7-9 (p < 0.001) and remained elevated until days 12-14 (p < 0.001). In subgroup analysis, significant increases of CSF ADMA levels were found in patients both with and without vasospasm. The KPS scores significantly correlated with CSF levels of ADMA at days 7-9 (correlation coefficient = -0.55, p = 0.012; 95% confidence interval -0.80 to -0.14). Binary logistic regression analysis indicated that higher ADMA level at days 7-9 predicted a poor clinical outcome at 2 year follow-up after SAH (odds ratio = 1.722, p = 0.039, 95% confidence interval 1.029 to 2.882). ADMA may be directly involved in the pathological process and future adverse prognosis of SAH. (C) 2014 Elsevier Ltd. All rights reserved.