The change of plasma pituitary adenylate cyclase-activating polypeptide levels after aneurysmal subarachnoid hemorrhage
The change of plasma pituitary adenylate cyclase-activating polypeptide levels after aneurysmal subarachnoid hemorrhage
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DOI：
10.1111/ane.12522
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发表时间：
2016-08-01
影响因子：
3.5
通讯作者：
Shen, Y. -F.
中科院分区：
文献类型：
--
作者：
Jiang, L.;Wang, W. -H.;Shen, Y. -F.
目的已证明循环垂体腺苷酸环化酶激活多肽（PACAP）水平升高与严重创伤性脑损伤的临床结果相关。目前的研究旨在确认升高的血浆 PACAP 水平是否可以预测动脉瘤性蛛网膜下腔出血 (aSAH) 的临床结果。材料和方法招募了 118 名 aSAH 患者和 118 名对照者。使用酶联免疫吸附测定法测定血浆 PACAP 浓度。对患者进行随访直至死亡或 aSAH 后 6 个月结束。格拉斯哥结果量表评分为 1-3 分为不良结果。结果所有患者入院时 PACAP 水平 (296.6 119.7 pg/ml) 与对照组 (77.1 +/- 17.9 pg/ml, P < 0.001) 相比显着升高。使用多元线性回归，血浆 PACAP 水平与世界神经外科医生联合会 (WFNS) 评分（t = 4.745，P < 0.001）和 Fisher 评分（t = 4.239，P < 0.001）所示的临床严重程度独立相关。 PACAP 被确定为 6 个月死亡率的独立预测因子 [比值比 (OR)，1.014； 95%置信区间（CI），1.005-1.030；使用二元 Logistic 回归分析和 Cox 比例分析得出 6 个月不良结果（OR，1.012；95% CI，1.006-1.028；P < 0.001）和 6 个月总生存率（风险比，1.016；95% CI，1.008-1.023；P < 0.001）分别进行危害分析。根据受试者工作特征曲线分析，PACAP与WFNS评分和Fisher评分具有相似的预测价值。结论较高的血浆PACAP水平与aSAH患者的临床严重程度和长期预后相关，PACAP有潜力成为aSAH良好的预后生物标志物。
ObjectiveElevated circulating pituitary adenylate cyclase-activating polypeptide (PACAP) levels have been demonstrated to be associated with clinical outcomes of severe traumatic brain injury. The current study aimed to confirm whether elevated plasma PACAP levels are predictive of clinical outcomes of aneurysmal subarachnoid hemorrhage (aSAH).Materials and methodsOne hundred and eighteen aSAH patients and 118 controls were recruited. Plasma PACAP concentrations were determined using enzyme-linked immunosorbent assay. Patients were followed up until death or completion of 6 months after aSAH. An unfavorable outcome was defined as Glasgow Outcome Scale score of 1-3.ResultsThe admission PACAP levels were significantly elevated in all patients (296.6 119.7 pg/ml) compared with controls (77.1 +/- 17.9 pg/ml, P < 0.001). Plasma PACAP levels were independently associated with clinical severity indicated by World Federation of Neurological Surgeons (WFNS) score (t = 4.745, P < 0.001) and Fisher score (t = 4.239, P < 0.001) using a multivariate linear regression. PACAP was identified as an independent predictor for 6-month mortality [odds ratio (OR), 1.014; 95% confidence interval (CI), 1.005-1.030; P < 0.001] and 6-month unfavorable outcome (OR, 1.012; 95% CI, 1.006-1.028; P < 0.001) and 6-month overall survival (hazard ratio, 1.016; 95% CI, 1.008-1.023; P < 0.001) using a binary logistic regression analysis and a Cox's proportional hazard analysis, respectively. PACAP had similar predictive values compared with WFNS score and Fisher score according to the receiver operating characteristic curve analysis.ConclusionsHigher plasma PACAP levels are associated with clinical severity and long-term prognosis of aSAH patients, and PACAP has potential to be a good prognostic biomarker of aSAH.