文献类型：期刊文献

中文题名：血清褪黑素在动脉瘤性蛛网膜下腔出血预后中的临床意义

英文题名：Clinical significance of serum melatonin in the prognosis of aneurysmal subarachnoid hemorrhage

作者：刘学武[1];孙守元[2];李富强[1];戴志成[1]

第一作者：刘学武

机构：[1]甘肃中医药大学第三附属医院神经外科,白银730900;[2]兰州大学第二医院神经外科,白银730900

第一机构：甘肃中医药大学第二附属医院

年份：2022

卷号：35

期号：6

起止页码：326

中文期刊名：立体定向和功能性神经外科杂志

外文期刊名：Chinese Journal of Stereotactic and Functional Neurosurgery

收录：CSTPCD

语种：中文

中文关键词：褪黑素;动脉瘤性蛛网膜下腔出血;疾病严重程度;预后

外文关键词：Melatonin;Aneurysmal subarachnoid hemorrhage;Disease severity;Prognosis

摘要：目的 分析血清褪黑素与动脉瘤性蛛网膜下腔出血(aSAH)短期功能预后的相关性。方法 在2018年10月至2021年5月,连续纳入因单一颅内动脉瘤破裂而首次出现蛛网膜下腔出血的患者168例。主要研究结局是发病90 d时神经功能不良,其定义为改良Rankin评分(mRS)为4~6分;良好结局定义为mRS为1~3分。次要结局为发病30d的不良结局及主要并发症的发生率。入组后采集静脉血,采用酶联免疫吸附试验法检测血清褪黑素水平。结果 根据mRS,将患者分为预后不良组(n=57)及预后良好组(n=111)。经Spearman分析,血清褪黑素水平与入院时世界神经外科医师联盟(WFNS)评分、Hunt&Hess分级、Fisher评分均呈显著正相关(r=0.442,0.476,0.239,P<0.05)。预后不良组aSAH患者的血清褪黑素显著高于预后良好组[7.10(4.50,12.00)pg/ml vs.4.00(3.00,5.00)pg/mL,P<0.001]。经受试者工作特征(ROC)曲线分析,血清褪黑素(0.790)预测aSAH发病后90d时预后不良的曲线下面积优于Hunt&Hess分级、Fisher评分(P<0.05)。经多因素Logistics回归分析,血清褪黑素水平>6.75 pg/mL为预测aSAH患者发病后90d时预后不良的独立危险因素(P<0.001)。此外,血清褪黑素水平(0.785)对预测aSAH发病后30 d预后也有良好价值。且术后迟发性脑缺血(DCI)患者血清褪黑素水平高于无DCI患者(P<0.001)。结论 血清褪黑激素可能作为aSAH的一个有前景的预后生物标志物。
Objective To analyze the correlation between serum melatonin and short-term functional prognosis of aneurysmal subarachnoid hemorrhage(aSAH).Methods From October 2018 to May 2021,168 patients with subarachnoid hemorrhage for the first time due to rupture of a single intracranial aneurysm were continuously included.The main outcome of the study was poor neurological function at 90 days after onset, which was defined as a modified Rankin score(mRS) of 4-6;Good outcome was defined as mRS of 1-3.The secondary outcomes were the adverse outcomes and the incidence of major complications after 30 days of onset.Venous blood was collected after enrollment, and serum melatonin level was detected by enzyme-linked immunosorbent assay.Results According to mRS,the patients were divided into poor prognosis group(n=57) and good prognosis group(n=111).By Spearman analysis, the serum melatonin level was significantly positively correlated with the World Federation of neurosurgeons(WFNS) score, Hunt & Hess score and Fisher score at admission(r=0.442,0.476,0.239,P<0.05).The serum melatonin of aSAH patients in poor prognosis group was significantly higher than that in good prognosis group [7.10(4.50,12.00) pg/ml vs.4.00(3.00,5.00) pg/ml, P<0.001].According to the ROC curve analysis, the area under the curve of serum melatonin(0.790) to predict the poor prognosis at 90 days after the onset of aSAH was better than Hunt & Hess grade and Fisher score(P<0.05).By multivariate logistic regression analysis, serum melatonin>6.75 pg/ml was an independent risk factor for predicting poor prognosis of aSAH patients 90 days after onset(P<0.001).In addition, the serum melatonin level(0.785) also has a good value in predicting the prognosis of aSAH 30 days after onset.The serum melatonin level in patients with delayed cerebral ischemia(DCI) was higher than that in patients without DCI(P<0.001).Conclusion Serum melatonin may serve as a promising prognostic biomarker for aSAH.