Aneurysmal subarachnoid hemorrhage

动脉瘤性蛛网膜下腔出血
  • 文章类型: Journal Article
    动脉瘤性蛛网膜下腔出血(aSAH)是一种危及生命的疾病,死亡率和发病率高。aSAH的改良Fisher等级与神经功能缺损之间存在实质性联系。本研究旨在使用机器学习方法分析与aSAH的修改Fisher等级相关的因素。
    进行了多中心观察性研究。从中国五家三级医院招募aSAH患者。使用改良的Fisher分级量表测量aSAH的出血量。分析了aSAH改良Fisher分级的危险因素,其中包括社会人口因素,临床因素,血液指数,动脉瘤破裂的特点。我们构建了几个基于树的机器学习模型(XGBoost,CatBoost,LightGBM)用于预测,并使用网格搜索来优化模型参数。综合评价模型,我们使用了准确性,Precision,接收器工作特性曲线下面积(AUROC),精确召回曲线下的面积(AUPRC),和Brier作为评价指标,评估模型性能,选择最优模型。
    共招募了888例aSAH患者,其中305人的Fisher改良等级为3级和4级。结果表明,XGBoost模型的AUROC最高,为0.772,各项指标优于CatBoost和LightGBM。特征重要性图显示顶部特征变量包括血小板,凝血酶时间,纤维蛋白原,入院前收缩压,活化部分凝血活酶时间,以及aSAH发作与首次CT检查之间的时间间隔。
    确定了导致aSAH改良Fisher等级的因素,这为未来的研究和临床干预提供了有价值的见解。在未破裂动脉瘤的治疗中应控制这些危险因素,如有必要,可以给予适当的治疗,以降低动脉瘤破裂后严重出血的风险。
    UNASSIGNED: Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening medical condition with a high fatality and morbidity rate. There was a substantial link between the modified Fisher grade of aSAH and the neurological function deficit. This study aimed to analyze the factors associated with the modified Fisher grade of aSAH using a machine learning approach.
    UNASSIGNED: A multi-center observational study was conducted. The patients with aSAH were recruited from five tertiary hospitals in China. The volume of hemorrhage in aSAH was measured using the modified Fisher grade scale. The risk factors responsible for the modified Fisher grade of aSAH were analyzed, which include sociodemographic factors, clinical factors, blood index, and ruptured aneurysm characteristics. We built several tree-based machine learning models (XGBoost, CatBoost, LightGBM) for prediction and used grid search to optimize model parameters. To comprehensively evaluate the model, we used Accuracy, Precision, Area Under the Receiver Operating Characteristic Curve (AUROC), Area Under the Precision-Recall Curve (AUPRC), and Brier as evaluation indicators to assess the model performance and select the best model.
    UNASSIGNED: A total of 888 patients with aSAH were recruited, of whom 305 with modified Fisher grade of 3 and 4. The results show that the XGBoost model has the highest AUROC of 0.772, and the indicators are better than CatBoost and LightGBM. The feature importance graph shows that the top feature variables include platelet, thrombin time, fibrinogen, preadmission systolic blood pressure, activated partial thromboplastin time, and the time interval between the onset of aSAH and the first-time CT examination.
    UNASSIGNED: The factors responsible for the modified Fisher grade of aSAH were identified, which offered valuable insights for future research and clinical intervention. These risk factors should be controlled in the treatment of unruptured aneurysms, and appropriate treatment can be given if necessary to reduce the risk of severe hemorrhage after aneurysm rupture.
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  • 文章类型: Case Reports
    在蛛网膜下腔出血和多发性动脉瘤患者中,准确识别破裂动脉瘤对于预防再出血和优化预后至关重要。增强血管壁MRI可以帮助查明罪魁祸首动脉瘤,为这些复杂病例提供量身定制的手术或血管内管理策略。在蛛网膜下腔出血(SAH)和多发性颅内动脉瘤的患者中,增强MRI和DSA对于识别破裂的动脉瘤至关重要,引导从血管内手术到显微外科手术的转变。成功的单节治疗和没有术后缺陷突出了多学科方法的有效性。需要进一步研究最优策略。
    多发性颅内动脉瘤约占动脉瘤性SAH病例的20%。在动脉瘤性SAH和多发性颅内动脉瘤患者中,明确治疗引起SAH的动脉瘤破裂是当务之急.然而,确定出血源可能很有挑战性,出血模式可能无法识别。多发性动脉瘤患者破裂动脉瘤的误诊和误治可导致出血复发和不良结果。我们报告了一名65岁的女性,她出现了严重的突发性头痛。神经影像学研究显示弥漫性SAH和并发PICA和ACom动脉瘤,一式三份A2。然而,根据常规的神经影像学研究,导致患者症状的动脉瘤破裂并不明显。进行了对比磁共振成像,显示PICA动脉瘤的周向增强。在这份报告中,我们证明了血管壁MRI在确定破裂动脉瘤和多发性动脉瘤的手术计划的决策方面的对比作用。此外,我们表明,在多发性动脉瘤的情况下,MRI和动脉瘤壁增强可能是检测破裂动脉瘤的有希望的选择。
    UNASSIGNED: Accurately identifying the ruptured aneurysm in patients with subarachnoid hemorrhage and multiple aneurysms is critical to prevent rebleeding and optimize outcomes. Vessel wall MRI with contrast can aid in pinpointing the culprit aneurysm, informing a tailored surgical or endovascular management strategy for these complex cases. In patients with subarachnoid hemorrhage (SAH) and multiple intracranial aneurysms, MRI with contrast and DSA are crucial for identifying the ruptured aneurysm, guiding a shift from endovascular to microsurgical clipping. Successful single-session treatment and absence of postsurgical deficits highlight the effectiveness of a multidisciplinary approach. Further research on optimal strategies is needed.
    UNASSIGNED: Multiple intracranial aneurysms make up approximately 20% of cases of aneurysmal SAH. In patients with aneurysmal SAH and multiple intracranial aneurysms, definite treatment of the ruptured aneurysm causing SAH is of the highest priority. However, identifying the bleeding source can be challenging, and it may not be recognizable by the hemorrhage pattern. Misdiagnosis and mistreatment of a ruptured aneurysm in a patient with multiple aneurysms can lead to bleeding recurrence and an undesirable outcome. We report a 65-year-old woman who presented with severe sudden onset headache. Neuroimaging studies revealed diffuse SAH and concurrent PICA and ACom aneurysm with triplicate A2. However, the ruptured aneurysm responsible for the patient\'s symptoms was not obvious based on routine neuroimaging studies. Magnetic resonance imaging with contrast was performed, revealing circumferential enhancement of the PICA aneurysm. In this report, we demonstrate the real-world effect of vessel wall MRI with contrast on decision-making regarding identifying the ruptured aneurysm and surgical planning in cases of multiple aneurysms. Furthermore, we show that MRI and aneurysm wall enhancement could be a promising option in detecting ruptured aneurysms in cases of multiple aneurysms.
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  • 文章类型: Journal Article
    背景:动脉瘤性蛛网膜下腔出血(aSAH)患者的有效治疗需要警惕的监测和治疗,考虑到脑血管痉挛和迟发性缺血性神经功能缺损(DINDs)等并发症的风险。经颅透射超声(TTUS)是一种公认的评估脑搏动性的技术。这项初步研究旨在探索TTUS在检测与DIND相关的脑内血流受损中的实用性。
    方法:作者检查了2名男性患者,年龄45岁和52岁,ASAHHunt和Hess分别为4级和2级,他们在临床过程中出现了DINDs。同时记录动脉血压,心率,和TTUS测量是在重症监护病房获得的。TTUS分析显示DIND发作期间异常的心律失常波型,而无DIND日的基线测量结果未显示异常.血管内痉挛后,TTUS表现出异常波的正常化,回到基线水平,除了神经系统症状的解决。
    结论:TTUS,一种评估大脑搏动的非侵入性方法,显示出有望作为监测aSAH患者的新工具,可能有助于及时诊断和额外的治疗干预。它为有延迟脑缺血风险的个体提供进一步见解的能力值得在临床研究中进一步研究。https://thejns.org/doi/10.3171/CASE24146。
    BACKGROUND: Effective management of patients with aneurysmal subarachnoid hemorrhage (aSAH) demands vigilant monitoring and treatment, given the risks of complications such as cerebral vasospasm and delayed ischemic neurological deficits (DINDs). Transcranial transmission ultrasound (TTUS) is a well-established technique for assessing brain pulsatility. This pilot study aims to explore the utility of TTUS in detecting impaired intracerebral blood flow associated with DINDs.
    METHODS: The authors examined 2 male patients, ages 45 and 52 years, with aSAH Hunt and Hess grades 4 and 2, respectively, who developed DINDs during their clinical course. Simultaneous recordings of arterial blood pressure, heart rate, and TTUS measurements were obtained in the intensive care unit. TTUS analysis revealed abnormal arrhythmic wave patterns during DIND episodes, whereas baseline measurements on DIND-free days showed no abnormalities. Following endovascular spasmolysis, TTUS demonstrated a normalization of abnormal waves, returning to baseline levels, alongside the resolution of neurological symptoms.
    CONCLUSIONS: TTUS, a noninvasive method for assessing brain pulsatility, shows promise as a novel tool for monitoring aSAH patients, potentially aiding in prompt diagnostics and additional therapeutic interventions. Its capacity to provide further insights for individuals at risk of delayed cerebral ischemia warrants further investigation in clinical studies. https://thejns.org/doi/10.3171/CASE24146.
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  • 文章类型: Journal Article
    动脉瘤性蛛网膜下腔出血(aSAH)患者通常预后较差。阴离子间隙(AG)已被证明与各种危重患者的死亡率相关。然而,低蛋白血症会导致对真实阴离子间隙水平的低估。本研究旨在验证单个AG和白蛋白校正阴离子间隙(ACAG)在aSAH患者中的预后价值。
    将单因素logistic回归分析中的重要因素纳入多因素logistic回归分析,以探索aSAH患者死亡的危险因素,并确认ACAG与死亡率之间的独立关系。限制性三次样条(RCS)用于直观显示ACAG水平与aSAH患者死亡风险之间的关系。通过将重要因素纳入多变量逻辑回归分析,建立了死亡率预测模型。通过计算受试者工作特征曲线下面积(AUC)来评估ACAG和开发模型的预后价值。
    在710名aSAH患者中,在20.3%的病例中观察到30天死亡率.使用RCS曲线证明aSAH患者的ACAG水平与死亡率之间存在正相关。多因素logistic回归分析有助于发现,在校正混杂效应后,只有六个因素与aSAH患者的死亡率最终且独立相关。包括亨特-赫斯量表评分(p=0.006),手术选择(p<0.001),白细胞计数(p<0.001),血清氯化物水平(p=0.023),ACAG(p=0.039),和迟发性脑缺血(p<0.001)。AG的AUC值,白蛋白,和ACAG在预测aSAH患者死亡率方面分别为0.606,0.536和0.617.逻辑回归模型,其中包括亨特-赫斯量表得分,手术选择,白细胞计数,血清氯化物水平,ACAG,和迟发性脑缺血,预测死亡率的AUC为0.911。
    ACAG是aSAH患者的有效预后标志物。纳入ACAG的预后模型可以帮助临床医生评估aSAH患者预后不良的风险。从而促进个性化治疗策略的制定。
    UNASSIGNED: Aneurysmal subarachnoid hemorrhage (aSAH) patients typically have poor prognoses. The anion gap (AG) has been proven to correlate with mortality in various critically ill patients. However, hypoalbuminemia can lead to underestimations of the true anion gap levels. This study was conducted to verify the prognostic value of single AG and albumin-corrected anion gap (ACAG) among aSAH patients.
    UNASSIGNED: Significant factors in the univariate logistic regression analysis were included in the multivariate logistic regression analysis to explore the risk factors for mortality in aSAH patients and to confirm the independent relationship between ACAG and mortality. The restricted cubic spline (RCS) was used to visually show the relationship between ACAG level and mortality risk of aSAH patients. The predictive model for mortality was developed by incorporating significant factors into the multivariate logistic regression analysis. The prognostic value of ACAG and the developed model was evaluated by calculating the area under the receiver operating characteristics curve (AUC).
    UNASSIGNED: Among 710 aSAH patients, a 30-day mortality was observed in 20.3% of the cases. A positive relationship was demonstrated between the ACAG level and mortality in aSAH patients using the RCS curve. The multivariate logistic regression analysis helped discover that only six factors were finally and independently related to mortality of aSAH patients after adjusting for confounding effects, including the Hunt-Hess scale score (p = 0.006), surgical options (p < 0.001), white blood cell count (p < 0.001), serum chloride levels (p = 0.023), ACAG (p = 0.039), and delayed cerebral ischemia (p < 0.001). The AUC values for the AG, albumin, and ACAG in predicting mortality among aSAH patients were 0.606, 0.536, and 0.617, respectively. A logistic regression model, which includes the Hunt-Hess scale score, surgical options, white blood cell count, serum chloride levels, ACAG, and delayed cerebral ischemia, achieved an AUC of 0.911 for predicting mortality.
    UNASSIGNED: The ACAG is an effective prognostic marker for aSAH patients. A prognostic model incorporating ACAG could help clinicians evaluate the risk of poor outcomes among aSAH patients, thereby facilitating the development of personalized therapeutic strategies.
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  • 文章类型: Journal Article
    INSPIRE随机临床试验表明,高蛋白饮食(HPRO)结合神经肌肉电刺激(NMES)可以减轻动脉瘤性蛛网膜下腔出血后的肌肉萎缩,并可能改善预后。在随机分配至护理标准(SOC;N=12)或HPRO+NMES(N=12)之前和在7天时从受试者入院时收集血液样品。对每个血浆样品进行非靶向代谢组学。稀疏偏最小二乘判别分析确定了区分每组的代谢物。计算每天每种代谢物和总蛋白质与肌肉体积之间的相关系数。多变量模型确定代谢物和肌肉体积之间的关联。鉴定独特的代谢物(18),将SOC与HPRO+NMES区分开。其中,9与蛋白质摄入量呈显著正相关。在多变量模型中,N-乙酰亮氨酸与保留的颞肌[OR1.08(95%CI1.01,1.16)]和四头肌[OR1.08(95%CI1.02,1.15)]肌肉体积显着相关。喹啉酸还与保留的颞肌[OR1.05(95%CI1.01,1.09)]和四头肌[OR1.04(95%CI1.00,1.07)]肌肉体积显着相关。N-乙酰丝氨酸和β-羟基异戊酰基肉碱与保留的颞肌或四头肌体积有关。定义HPRO+NMES的代谢物与蛋白质摄入有很强的相关性,并且与保留的肌肉体积相关。
    The INSPIRE randomized clinical trial demonstrated that a high protein diet (HPRO) combined with neuromuscular electrical stimulation (NMES) attenuates muscle atrophy and may improve outcomes after aneurysmal subarachnoid hemorrhage We sought to identify specific metabolites mediating these effects. Blood samples were collected from subjects on admission prior to randomization to either standard of care (SOC; N = 12) or HPRO + NMES (N = 12) and at 7 days. Untargeted metabolomics were performed for each plasma sample. Sparse partial least squared discriminant analysis identified metabolites differentiating each group. Correlation coefficients were calculated between each metabolite and total protein per day and muscle volume. Multivariable models determined associations between metabolites and muscle volume. Unique metabolites (18) were identified differentiating SOC from HPRO + NMES. Of these, 9 had significant positive correlations with protein intake. In multivariable models, N-acetylleucine was significantly associated with preserved temporalis [OR 1.08 (95% CI 1.01, 1.16)] and quadricep [OR 1.08 (95% CI 1.02, 1.15)] muscle volume. Quinolinate was also significantly associated with preserved temporalis [OR 1.05 (95% CI 1.01, 1.09)] and quadricep [OR 1.04 (95% CI 1.00, 1.07)] muscle volume. N-acetylserine and β-hydroxyisovaleroylcarnitine were associated with preserved temporalis or quadricep volume. Metabolites defining HPRO + NMES had strong correlations with protein intake and were associated with preserved muscle volume.
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  • 文章类型: Journal Article
    我们旨在研究具有不同3个月结局的动脉瘤性蛛网膜下腔出血(aSAH)患者的血清代谢组学特征(良好=改良的Rankin评分:0-3与差=mRS4-6)。我们在受伤后24(D1)和168(D7)小时收集了46例aSAH患者的血清样本,用于液相色谱-质谱分析。鉴定了96种不同的代谢物。使用多变量(正交偏最小二乘判别分析)比较组,单变量,和接收操作员特征(ROC)方法。与早期(D1)相比,我们观察到晚期(D7)的血清同型半胱氨酸水平显着降低。在D1和D7,甘露糖和山梨糖水平明显较高,随着犬尿氨酸(D1)水平升高和2-羟基丁酸增加,甲基半乳糖苷,肌酸,黄苷,对羟基苯基乙酸酯,N-乙酰丙氨酸,和N-乙酰甲硫氨酸(所有D7)在不良结局组。相反,在预后不良的患者中,胍基乙酸盐(D7)和几种氨基酸(D1和D7)水平显著降低.我们的结果表明能量代谢发生了显著变化,转向酮症和替代能源,无论是在早期还是后期,即使有足够的肠内营养,特别是在预后不良的患者中。犬尿氨酸途径的早期激活也可能在该过程中起作用。
    We aimed to investigate the characteristics of serum metabolomics in aneurysmal subarachnoid hemorrhage patients (aSAH) with different 3-month outcomes (good = modified Rankin score: 0-3 vs. poor = mRS 4-6). We collected serum samples from 46 aSAH patients at 24 (D1) and 168 (D7) hours after injury for analysis by liquid chromatography-mass spectrometry. Ninety-six different metabolites were identified. Groups were compared using multivariate (orthogonal partial least squares discriminant analysis), univariate, and receiving operator characteristic (ROC) methods. We observed a marked decrease in serum homocysteine levels at the late phase (D7) compared to the early phase (D1). At both D1 and D7, mannose and sorbose levels were notably higher, alongside elevated levels of kynurenine (D1) and increased 2-hydroxybutyrate, methyl-galactoside, creatine, xanthosine, p-hydroxyphenylacetate, N-acetylalanine, and N-acetylmethionine (all D7) in the poor outcome group. Conversely, levels of guanidinoacetate (D7) and several amino acids (both D1 and D7) were significantly lower in patients with poor outcomes. Our results indicate significant changes in energy metabolism, shifting towards ketosis and alternative energy sources, both in the early and late phases, even with adequate enteral nutrition, particularly in patients with poor outcomes. The early activation of the kynurenine pathway may also play a role in this process.
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  • 文章类型: Journal Article
    早期全身性炎症改变越来越被认为是动脉瘤性蛛网膜下腔出血(aSAH)后预后的影响因素。全身炎症反应指数(SIRI),炎症生物标志物,被认为与许多其他疾病的不良后果有关。然而,在ASAH中,对SIRI的研究仍然有限。因此,我们的目的是调查SIRI与不良长期功能结局之间的关联,同时评估院内并发症在该关联中的中介作用.
    SIRI定义为中性粒细胞计数×单核细胞计数/淋巴细胞计数。根据SIRI四分位数对患者进行分类。使用稳定的治疗加权的逆概率(sIPTW)来最小化组差异。通过多变量逻辑回归分析估计SIRI与住院并发症以及不良90天功能结局(mRS3-6)之间的关联。进行中介分析以研究SIRI与院内并发症介导的不良功能结局之间的关系。
    共纳入650例患者。在SIPTW之后,与最低四分位数相比,SIRI升高与迟发性脑缺血(DCI)相关(OR2.12,95%CI1.20-3.74),术后肺炎(POP)(OR2.16,95%CI1.29-3.62)和90天功能结局差(OR3.03,95%CI1.55-5.91)。住院并发症,包括DCI(调解比例,sIPTW前18.18%和sIPTW后20.0%)和POP(调解比例,sIPTW之前的18.18%和sIPTW之后的26.7%)部分介导了SIRI与90天不良功能结局之间的关联。中介分析在按年龄和性别分层的亚组中产生了可比的结果。
    在这项研究中,SIRI与aSAH不良的长期功能结局相关,部分由DCI和POP介导,介导比例超过18%。我们的发现可能强调了SIRI在促使医生及时解决全身炎症状态以预防院内并发症方面的潜在效用。包括DCI和POP,并最终改善长期功能结果。
    UNASSIGNED: Early systemic inflammatory changes are increasingly recognized as factors influencing outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Systemic inflammation response index (SIRI), an inflammation biomarker, was thought to be associated with adverse outcomes in many other diseases. However, in aSAH, research on SIRI remains limited. Thus, our objective was to investigate the association between SIRI and poor long-term functional outcomes while evaluating the mediating role of in-hospital complications in this association.
    UNASSIGNED: SIRI was defined as neutrophil count × monocyte count/lymphocyte count. Patients were categorized according to SIRI quartiles. Stabilized inverse probability of treatment weighting (sIPTW) was utilized to minimize group differences. The association between SIRI and in-hospital complications as well as poor 90-day functional outcomes (mRS 3-6) was estimated by multivariable logistic regression analyses. Mediation analysis was performed to investigate the relationship between SIRI and poor functional outcomes mediated by in-hospital complications.
    UNASSIGNED: A total of 650 patients were prospectively included. After sIPTW, compared to the lowest quartile, an elevated SIRI was associated with delayed cerebral ischemia (DCI) (OR 2.12, 95% CI 1.20-3.74), post-operative pneumonia (POP) (OR 2.16, 95% CI 1.29-3.62) and poor 90-day functional outcomes (OR 3.03, 95% CI 1.55-5.91). In-hospital complications including DCI (mediation proportion, 18.18% before sIPTW and 20.0% after sIPTW) and POP (mediation proportion, 18.18% before sIPTW and 26.7% after sIPTW) partially mediated the association between SIRI and poor 90-day functional outcomes. Mediation analysis yielded comparable results in subgroups stratified by age and sex.
    UNASSIGNED: In this study, SIRI was associated with poor long-term functional outcomes in aSAH, which was partially mediated by DCI and POP with a mediation proportion exceeding 18%. Our findings might underscore the potential utility of SIRI in prompting physicians to address systemic inflammatory status timely to prevent in-hospital complications, including DCI and POP, and ultimately improve long-term functional outcomes.
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  • 文章类型: Clinical Trial Protocol
    背景:动脉瘤性蛛网膜下腔出血(aSAH)是一种危及生命的神经外科急症,死亡率高。迟发性脑缺血(DCI)和脑血管痉挛(CVS)是早期脑损伤(EBI)的迟发性产品,这可能构成患者预后不良的主要决定因素。因此,DCI和CVS的缓解在追求改善患者预后方面具有至关重要的意义.然而,除了口服尼莫地平,目前的指南中没有有效的治疗方法.因此,迫切需要提供新的治疗范式。在基础研究中已经大量报道了氢治疗靶标的多样性,揭示了其改善aSAH患者EBI的潜在能力。
    方法:动脉瘤性蛛网膜下腔出血(HOMA)患者的早期氢-氧混合气体吸入,一个单一的中心,prospective,开放标签,随机对照临床试验,努力评估氢氧混合气体吸入疗法在aSAH患者中的有效性和安全性。将206名患者随机分为氢氧混合气体吸入组(每天8小时,3L/min,氢浓度为67%,氧浓度为33%)或吸氧组(每天8小时,3L/min,在aSAH后72小时内氧气浓度为33%),并在ICU病房治疗7天。主要结果是住院期间DCI和CVS的发生率。
    结论:HOMA旨在评估氢氧混合气体吸入疗法在预防DCI或CVS和改善aSAH患者预后方面的有效性。值得注意的是,这是首次在aSAH患者中进行氢气治疗的大规模试验.鉴于中国人口占全球人口的很大一部分,并且由于老龄化导致中风的发病率不断增加,优化患者护理至关重要。鉴于目前在aSAH患者预后方面的挑战,启动更多前瞻性临床试验至关重要.最近的研究表明氢的治疗潜力,与ASAH中的EBI对齐,推动我们探索氢气治疗动脉瘤破裂后损伤的机制。
    背景:HOMA研究方案获得北京天坛医院伦理委员会批准,首都医科大学(KY2022-020-02)。本研究的所有结果将发表在同行评审的期刊上,并在相关会议上发表。
    背景:ClinicalTrials.govNCT05282836。2022年3月16日注册。
    BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening neurosurgical emergency with a high mortality rate. Delayed cerebral ischemia (DCI) and cerebral vasospasm (CVS) are delayed products of early brain injury (EBI), which may constitute the principal determinant of an unfavorable patient prognosis. Consequently, the mitigation of DCI and CVS assumes paramount significance in the pursuit of enhanced patient outcomes. However, except for oral nimodipine, there is no effective therapy available in the current guideline. Hence, the exigency arises to proffer novel treatment paradigms. The diversity of hydrogen therapeutic targets has been largely reported in basic research, unveiling its latent capacity to ameliorate EBI in aSAH patients.
    METHODS: Early Hydrogen-Oxygen Gas Mixture Inhalation in Patients with Aneurysmal Subarachnoid Hemorrhage (HOMA), a single-center, prospective, open-labeled, randomized controlled clinical trial, endeavors to evaluate the efficacy and safety of hydrogen-oxygen gas mixture inhalation therapy in aSAH patients. A cohort of 206 patients will be randomized to either hydrogen-oxygen gas mixture inhalation group (8 h per day, 3 L/min, hydrogen concentration of 67%, oxygen concentration of 33%) or oxygen inhalation group (8 h per day, 3 L/min, oxygen concentration of 33%) within 72 h after aSAH and treated for 7 days in the ICU ward. The primary outcomes are the incidence of DCI and CVS during hospitalization.
    CONCLUSIONS: The HOMA aims to evaluate the effectiveness of hydrogen-oxygen gas mixture inhalation therapy in preventing DCI or CVS and improving outcomes in aSAH patients. Notably, this is the first large-scale trial of hydrogen therapy in aSAH patients. Given that the Chinese population represents a significant portion of the global population and the increasing incidence of stroke due to aging, optimizing patient care is vital. Given the current challenges in aSAH patient outcomes, initiating more prospective clinical trials is essential. Recent research has shown hydrogen\'s therapeutic potential, aligning with EBI in aSAH, driving our exploration of hydrogen therapy\'s mechanisms in post-aneurysm rupture damage.
    BACKGROUND: The protocol for the HOMA study was approved by the Ethics Committee of Beijing Tiantan Hospital, Capital Medical University (KY 2022-020-02). All results of the present study will be published in peer-reviewed journals and presented at relevant conferences.
    BACKGROUND: ClinicalTrials.gov NCT05282836. Registered on March 16, 2022.
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  • 文章类型: Journal Article
    探索与动脉瘤性蛛网膜下腔出血(aSAH)患者预后相关的因素已成为研究热点。我们试图研究脑脊液中炎症标志物和血细胞计数与aSAH患者预后的关系。
    我们进行了一项回顾性研究,包括200例aSAH和手术患者。中性粒细胞的关联,淋巴细胞,中性粒细胞-淋巴细胞比率(NLR),血小板-淋巴细胞比率(PLR),全身免疫炎症指数(SII),系统炎症反应指数(SIRI),采用单因素分析和多因素logistic回归模型对aSAH患者术后第1天和第7天脑脊液中血细胞计数与预后的关系进行研究。
    根据改良的Rankin量表(mRS)评分,其中147例患者预后良好,53例患者预后不良.中性粒细胞,NLR,SIRI,结果差的患者在术后第七天的SII水平均明显高于结果好的患者,P<0.05。术后第1天脑脊液中的炎性标志物和血细胞计数的多因素logistic回归模型证实,脑脊液中的红细胞计数(≥177×109/L;OR:7.227,95%CI:1.160-45.050,P=0.034)可能与aSAH患者的不良预后有关。手术时间(≥169分钟),费舍尔等级(III-IV),高血压,感染也可能与不良结局相关。在术后第7天,包括炎症标志物和脑脊液中的血细胞计数的模型证实,脑脊液中的红细胞计数(≥54×109/L;OR:39.787,95%CI:6.799-232.836,P<0.001)和中性粒细胞-淋巴细胞比率(≥8.16;OR:6.362,95%CI:1.424-28.428,P=0.015)均可能与SAH患者的不良预后有关。NLR(r=0.297,P=0.007)和SIRI(r=0.325,P=0.003)水平均与脑脊液红细胞计数相关。
    较高的中性粒细胞-淋巴细胞比率和较高的脑脊液红细胞计数都可能与动脉瘤性蛛网膜下腔出血患者的不良预后有关。然而,我们需要一个更大的样本研究。
    UNASSIGNED: Exploring factors associated with the outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH) has become a hot focus in research. We sought to investigate the associations of inflammatory markers and blood cell count in cerebrospinal fluid with the outcome of aSAH patients.
    UNASSIGNED: We carried a retrospective study including 200 patients with aSAH and surgeries. The associations of neutrophil, lymphocyte, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune inflammation index (SII), system inflammation response index (SIRI), and blood cell count in cerebrospinal fluid on the 1st and 7th postoperative days with the outcome of aSAH patients were investigated by univariate analysis and multivariate logistic regression model.
    UNASSIGNED: According to the modified Rankin scale (mRS) score, there were 147 patients with good outcome and 53 patients with poor outcome. The neutrophil, NLR, SIRI, and SII levels on the seventh postoperative day in patients with poor outcome were all significantly higher than patients with good outcome, P < 0.05. The multivariate logistic regression model including inflammatory markers and blood cell counts in cerebrospinal fluid on the 1st postoperative day confirmed that red blood cell count in cerebrospinal fluid (≥177 × 109/L; OR: 7.227, 95% CI: 1.160-45.050, P = 0.034) was possibly associated with poor outcome of aSAH patients, surgical duration (≥169 min), Fisher grade (III-IV), hypertension, and infections were also possibly associated with the poor outcome. The model including inflammatory markers and blood cell counts in cerebrospinal fluid on the 7th postoperative day confirmed that red blood cell count in cerebrospinal fluid (≥54 × 109/L; OR: 39.787, 95% CI: 6.799-232.836, P < 0.001) and neutrophil-lymphocyte ratio (≥8.16; OR: 6.362, 95% CI: 1.424-28.428, P = 0.015) were all possibly associated with poor outcome of aSAH patients. The NLR (r = 0.297, P = 0.007) and SIRI (r = 0.325, P = 0.003) levels were all correlated with the count of red blood cells in cerebrospinal fluid.
    UNASSIGNED: Higher neutrophil-lymphocyte ratio and higher red blood cell count in cerebrospinal fluid were all possibly associated with poor outcome of patients with aneurysmal subarachnoid hemorrhage. However, we need a larger sample study.
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  • 文章类型: Journal Article
    到目前为止,可溶性生长刺激表达基因2(sST2)的血清浓度似乎对动脉瘤性蛛网膜下腔出血(aSAH)患者具有预后价值。本研究旨在探讨aSAH患者脑脊液sST2浓度与预后的关系。
    选取2021年3月至2022年8月济宁市第一人民医院神经外科符合纳入标准的65例aSAH患者作为研究对象。将3个月改良Rankin量表(mRS)评分为0-2分的35例患者分为预后良好组,将30例3个月mRS评分为3~5分的患者分为预后不良组。在动脉瘤手术后的前5天通过腰椎穿刺收集CSF。使用酶联免疫吸附测定确定CSFsST2浓度。
    在所有患者中,CSFsST2浓度最初增加,在第2天达到峰值,然后下降。与预后良好组相比,预后不良组的sST2浓度在aSAH术后1,2,3,4和5天显著升高.CSFsST2浓度在预测结果方面表现出良好的诊断性能(受试者工作特征曲线下面积=0.988)。此外,CSFsST2浓度对预测脑水肿具有良好的性能,但仅限于预后不良组(曲线下面积=0.93)。
    CSFsST2浓度升高与aSAH患者的不良预后相关。CSFsST2在这些患者中可能具有作为预测性生物标志物的作用。
    UNASSIGNED: Serum concentration of soluble growth stimulation expressed gene 2 (sST2) appears to have prognostic value in patients with aneurysmal subarachnoid hemorrhage (aSAH) by now. This study aimed to investigate the relationship between cerebrospinal fluid (CSF) sST2 concentration and outcome in patients with aSAH.
    UNASSIGNED: A total of 65 aSAH patients who met the inclusion criteria in the Neurosurgery Department of Jining No.1 People\'s Hospital from March 2021 to August 2022 were selected as the research objects. 35 patients with the third month Modified-Rankin-Scale (mRS) score of 0-2 were divided into good prognosis group, and 30 patients with the third month mRS score of 3-5 were divided into poor prognosis group. CSF was collected by lumbar puncture for the first 5 days after aneurysm surgery. CSF sST2 concentration was determined using an enzyme-linked immunosorbent assay.
    UNASSIGNED: In all patients, CSF sST2 concentrations initially increased, peaked on day 2, and then decreased. Compared with the good prognosis group, the sST2 concentration was significantly increased in the poor prognosis group at 1, 2, 3, 4 and 5 days after aSAH surgery. CSF sST2 concentration exhibited good diagnostic performance for predicting outcome (area under the receiver operating characteristic curve = 0.988). Additionally, CSF sST2 concentration has good performance for predicting cerebral edema, but only in the poor prognosis group (area under the curve = 0.93).
    UNASSIGNED: Elevated CSF sST2 concentration is associated with poor outcome in aSAH patients. CSF sST2 may have a role as a predictive biomarker in these patients.
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