Axonal damage and outcome in subarachnoid haemorrhage
Axonal damage and outcome in subarachnoid haemorrhage
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DOI：
10.1136/jnnp.2005.085175
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发表时间：
2006-06-01
影响因子：
11
通讯作者：
Thompson, E. J.
中科院分区：
文献类型：
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作者：
Petzold, A.;Keir, G.;Thompson, E. J.
背景资料：蛛网膜下腔出血（SAH）患者的初步证据的基础上，轴突变性被认为是一个被低估的病理feature.Methods：纵向研究17例蛛网膜下腔出血。每天收集脑室CSF，持续14天。神经丝重链（SMI 35）（NfH（SMI 35），轴突损伤的生物标志物）使用标准ELISA定量（正常上限0.73 ng/ml）。主要结果测量是3个月时的格拉斯哥结果评分（GOS）。结果：在148例SAH患者的样本中，78例（52.7%）样本中发现CSF中病理性高NfH水平，而参考人群的416例样本中有20例（5%）（p < 0.0001）。在所有预后不良（GOS 1-3）的患者中观察到NfH的病理性增加，而在预后良好（GOS 4-5，p < 0.0001）的患者中观察到NfH的病理性增加为8%。这种增加通常在出血后7天变得显著（p < 0.01）。通过分析CSF中的个体平均NfH浓度（3.45对0.37 ng/ml，p < 0.01）证实了该结果，并且通过CSF中的NfH与GOS的负相关性（r =-0.65，p < 0.01）加强了该结果。发现损伤的严重程度与CSF中的NfH（SMI 35）水平相关（世界神经外科医生联合会，r = 0.63，p < 0.01和格拉斯哥昏迷评分，r =-0.61，p < 0.01）。
Background: On the basis of preliminary evidence from patients with subarachnoid haemorrhage (SAH), axonal degeneration is thought to be an underestimated pathological feature.Methods: A longitudinal study in 17 patients with aneurysmal SAH. Ventricular CSF was collected daily for up to 14 days. The neurofilament heavy chain(SMI35) (NfH(SMI35), a biomarker for axonal damage) was quantified using a standard ELISA (upper limit of normal 0.73 ng/ml). The primary outcome measure was the Glasgow Outcome Score (GOS) at 3 months.Results: Of 148 samples from patients with SAH, pathologically high NfH levels in the CSF were found in 78 (52.7%) samples, compared with 20 (5%) of 416 samples from the reference population (p < 0.0001). A pathological increase in NfH was observed in all patients with a bad outcome (GOS 1-3) compared with 8% of those with a good outcome (GOS 4-5, p < 0.0001). This increase typically became significant 7 days after the haemorrhage (p < 0.01). The result was confirmed by analysing the individual mean NfH concentrations in the CSF (3.45 v 0.37 ng/ml, p < 0.01), and was reinforced by the inverse correlation of NfH in the CSF with the GOS (r = -0.65, p < 0.01). Severity of injury was found to be correlated to NfH(SMI35) levels in the CSF (World Federation of Neurological Surgeons, r = 0.63, p < 0.01 and Glasgow Coma Score, r = -0.61, p < 0.01).Conclusion: Patients with SAH thus have secondary axonal degeneration, which may adversely affect their outcome.