Abstract：
Hyperglycemia during early brain injury (EBI) period after spontaneous subarachnoid hemorrhage (SAH) is associated with poor outcome, but the underlying physiopathology is unknown. This study assessed if hyperglycemia during EBI is associated with markers of neuroaxonal injury and whether these biomarkers partially account for the association between hyperglycemia and poor clinical outcome. Ninety-two SAH patients admitted within 24 h of bleeding onset were prospectively included. Glucose levels were measured at arrival and every 6 h for 72 h. Serum neurofilament light chain (NFL) levels were measured at 72 h. Functional outcome was assessed with the modified Rankin Scale (mRS) at 90 days (poor outcome, mRS > 2). The association between glucose metrics, NFL levels, and clinical outcome was assessed with univariate and multivariate analyses. Mediation analysis was performed to examine the potential chain in which NFL may mediate the relationship between glucose and functional outcome. Higher glucose and NFL levels during EBI were associated with poor clinical outcome in adjusted analysis. NFL levels were associated with older age, higher initial severity, and higher glucose levels during EBI period. In adjusted mediation analyses, the association between glucose and clinical outcome was significantly mediated by NFL levels. The mediator NFL explained 25% of the association between glucose during EBI period and poor functional outcome at 90 days. In SAH, the association between glucose levels during EBI and poor clinical outcome might be significantly mediated by NFL levels. The link between hyperglycemia and poor clinical outcome might be explained in part through secondary neuroaxonal injury.
摘要：
自发性蛛网膜下腔出血（SAH）后早期脑损伤（EBI）期间的高血糖与不良预后相关，但潜在的病理生理学是未知的。这项研究评估了EBI期间的高血糖是否与神经轴突损伤的标志物相关，以及这些生物标志物是否部分解释了高血糖与不良临床结果之间的关联。前瞻性纳入了出血发作24小时内收治的92例SAH患者。在到达时和每6小时测量葡萄糖水平，持续72小时。在72小时测量血清神经丝轻链（NFL）水平。在90天使用改良的Rankin量表（mRS）评估功能结果（不良结果，MRS>2）。葡萄糖指标之间的关联，NFL水平，通过单因素和多因素分析评估临床结局.进行中介分析以检查NFL可能介导葡萄糖与功能结果之间关系的潜在链。在调整分析中，EBI期间较高的葡萄糖和NFL水平与不良的临床结果相关。NFL水平与年龄有关，较高的初始严重性，和较高的葡萄糖水平在EBI期间。在调整后的调解分析中，血糖和临床结局之间的关联是由NFL水平显著介导的.介体NFL解释了EBI期间葡萄糖与90天不良功能结果之间25%的关联。在SAH,EBI期间葡萄糖水平与不良临床结局之间的关联可能由NFL水平显著介导.高血糖与不良临床结果之间的联系可能部分是通过继发性神经轴索损伤来解释的。
