C-reactive protein and vasospasm after aneurysmal subarachnoid hemorrhage1
C-reactive protein and vasospasm after aneurysmal subarachnoid hemorrhage1
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DOI：
10.1590/s0102-86502014000500009
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发表时间：
2014-05-01
期刊：
影响因子：
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通讯作者：
Cataneo, Antonio José Maria
中科院分区：
文献类型：
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作者：
Romero, Flávio Ramalho;Cataneo, Daniele Cristina;Cataneo, Antonio José Maria
目的：探讨动脉瘤性蛛网膜下腔出血后C反应蛋白水平与临床及放射学参数与迟发性脑缺血神经功能障碍及预后的关系。除了基线特征外，还前瞻性地测量了蛛网膜下腔出血后110天的每日C-反应蛋白水平。主要终点是格拉斯哥预后评分结果，其次是迟发性缺血性神经功能障碍(DINDS)的发生。结果：CRP水平从入院到发病后第3天呈进行性升高，随后缓慢下降至第9天。TCD的血流动力学改变与血清C反应蛋白水平升高有关。GCS评分越低的患者，CRP水平越高。入院时Hunt和Hess评分较高的患者出现明显较高的CRP Scrum水平。入院时Fisher分级越高，C反应蛋白水平越高。在我们的研究中，血清C反应蛋白水平与出院时的GOS和C反应蛋白水平呈显著负相关。结论：血清C反应蛋白水平越高，临床预后越差，迟发性缺血性神经功能障碍的发生率越高。由于C反应蛋白水平在早期阶段显著升高，它们可能是一个有用的监测参数。
PURPOSE: To evaluate the relationship between C reactive protein levels and clinical and radiological parameters with delayed ischemic neurological deficits and outcome after aneurysmal subarachnoid hemorrhage.METHODS: One hundred adult patients with aneurismal SAH were prospectively evaluated. Besides the baseline characteristics, daily C-reactive protein levels were prospectively measured until day 110 after subarachnoid hemorrhage. The primary end point was outcome assessed by Glasgow Outcome Scale, the secondary was the occurrence of delayed ischemic neurological deficits (DINDs).RESULTS: A progressive increase in the CRP levels from the admission to 3rd postictal day was observed, followed by a slow decrease until the 9th day. Hemodynamic changes in TCD were associated with higher serum CRP levels. Patients with lower GCS scores presented with increased CRP levels. Patients with higher Hunt and Hess grades on admission developed significantly higher CRP scrum levels. Patients with higher admission Fisher grades showed increased levels of CRP. A statistically significant inverse correlation was established in our series between CRP serum levels and GOS on discharge and CRP levels.CONCLUSIONS: Higher C-reactive protein serum levels are associated with worse clinical outcome and the occurrence of delayed ischemic neurological deficits. Because C-reactive protein levels were significantly elevated in the early phase, they might be a useful parameter to monitor.