Increased Plasma Galectin-3 Preceding the Development of Delayed Cerebral Infarction and Eventual Poor Outcome in Non-Severe Aneurysmal Subarachnoid Hemorrhage
Increased Plasma Galectin-3 Preceding the Development of Delayed Cerebral Infarction and Eventual Poor Outcome in Non-Severe Aneurysmal Subarachnoid Hemorrhage
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DOI：
10.1007/s12975-017-0564-0
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发表时间：
2018-04-01
影响因子：
6.9
通讯作者：
Suzuki, Hidenori
中科院分区：
文献类型：
--
作者：
Nishikawa, Hirofumi;Nakatsuka, Yoshinari;Suzuki, Hidenori
基质细胞蛋白半乳糖凝集素 3 参与组织损伤和炎症，但半乳糖凝集素 3 在动脉瘤性蛛网膜下腔出血 (SAH) 中的作用仍不清楚。本研究的目的是评估急性期半乳糖凝集素 3 水平是否与 SAH 后神经血管事件的后续发展和结局相关。这项研究包括 83 名连续诊断为世界神经外科医生联合会 (WFNS) 1-3 级动脉瘤性蛛网膜下腔出血的患者。在第 1-3 天（剪发或卷绕后的第二天）测量一次血浆半乳糖凝集素 3 水平。 15 名患者的预后较差，这与年龄增加、女性、发病前发病率增加、WFNS 分级较差、改良 Fisher 计算机断层扫描量表、急性脑积水以及与良好预后相比较高的半乳糖凝集素 3 水平有关。多变量分析显示，血浆半乳糖凝集素-3 是不良预后的独立决定因素（比值比，3.08；95% 置信区间，1.58-6.00；p = 0.001）。在第 4 天及之后发生的 SAH 后神经血管事件中，第 1-3 天血浆半乳糖凝集素 3 水平显着升高，但延迟性脑缺血和梗塞，但不包括血管造影血管痉挛和分流依赖性脑积水。受试者工作特征曲线表明，血浆半乳糖凝集素-3的截断值为3.30或3.48 ng/ml，可预测脑梗死发展迟缓或预后不良（特异性分别为62.5%、70.6%；敏感性分别为90.9%、73.3%）。研究结果表明，第 1-3 天的血浆半乳糖凝集素 3 水平将是预测迟发性脑梗塞的后续发展和最终不良结果的有用生物标志物，并提供了一个新的候选者，它可能在 SAH 后早期脑损伤或炎症与无血管痉挛的迟发性脑梗塞之间介导。
A matricellular protein galectin-3 is involved in tissue injury and inflammation, but the role of galectin-3 remains unclear in aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to assess whether acute-stage galectin-3 levels were associated with the subsequent development of neurovascular events and outcome after SAH. This study included 83 consecutive patients diagnosed with aneurysmal SAH of resuscitated World Federation of Neurological Surgeons (WFNS) grades 1-3. Plasma galectin-3 levels were once measured on days 1-3 (the day after clipping or coiling). Fifteen patients had poor outcomes, which were associated with increasing age, female, pre-onset morbidity, worse WFNS grade, modified Fisher computed tomography scale, acute hydrocephalus, and higher galectin-3 levels compared with good outcomes. Multivariate analyses revealed that plasma galectin-3 was an independent determinant for poor outcome (odds ratio, 3.08; 95% confidence interval, 1.58-6.00; p = 0.001). Among post-SAH neurovascular events occurring on day 4 and thereafter, delayed cerebral ischemia and infarction, but not angiographic vasospasm and shunt-dependent hydrocephalus, showed significantly higher plasma galectin-3 levels on days 1-3. The receiver operating characteristic curve indicated that plasma galectin-3 with a cutoff value of 3.30 or 3.48 ng/ml predicted delayed cerebral infarction development or poor outcome (specificity, 62.5%, 70.6%; sensitivity, 90.9%, 73.3%, respectively). The findings suggest that plasma galectin-3 levels on days 1-3 would be a useful biomarker for predicting subsequent development of delayed cerebral infarction and eventual poor outcome and provide a new candidate, which may mediate between post-SAH early brain injury or inflammation and delayed cerebral infarction without vasospasm.