C-反应蛋白与动脉瘤性蛛网膜下腔出血临床预后的关系

目的探讨动脉瘤性蛛网膜下腔出血(a SAH)血清C-反应蛋白(CRP)动态变化趋势及其与临床预后的关系。方法2014年1月至2015年8月前瞻性收集符合标准的a SAH 108例,发病72 h内行夹闭术(72例)或血管内栓塞(36例)。术后3个月采用GOS评分评估预后,4~5分为预后良好,1~3分为预后不良。入院时、术后1、3、5、7 d及出院当天,采集清晨空腹静脉血,检测血清CRP水平。采用多因素Logistic回归分析检验预后不良危险因素。结果 108例中,预后良好68例,预后不良40例。多因素Logistic回归分析显示,术后1、3 d血清CRP水平增高是a SAH不良预后的独立危险因素。受试者工作特征曲线分析结果术后3 d血清CRP水平曲线下面积(AUC)=0.823]与术后1 d(AUC=0.861)相比,对不良预后的发生具有更好的预测价值。术后1 d血清CRP与入院时GCS评分、入院时Fisher评分和入院时Hunt-Hess分级均无明显相关性(P0.05)。术后3 d血清CRP水平与入院时GCS评分无明显相关性,但与入院时Fisher评分(r=0.28;P0.05)、入院时Hunt-Hess分级(r=0.42;P0.05)存在明显相关性。结论术后3 d血清CRP水平升高是a SAH不良预后的独立危险因素,能为不良预后的识别提供临床指导。

Relationship between serum level of C-reactive protein and prognoses in patients with aneurysmal subarachnoid hemorrhage

Objective To investigate the relationship between the serum level of C-reactive protein (CRP) and prognoses in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods The serum levels of CRP were determined before and 1, 3, 5 and 7 days after the operation and on discharge from hospital in 108 patients with aSAH from January, 2014 to August, 2015. Univariate and multivariate logistic regression analyses were used to explore the relationship of the serum levels of CRP with clinical outcomes. Receiver operating characteristic (ROC) curves were obtained to investigate the value of CRP to predicting the prognoses in the patients with aSAH. Results Of 108 patients, 68 patients had good outcome and 40 had poor outcome according to GOS score 3 months after operation. The serum levels of CRP were significantly higher in 40 patients with poor outcomes than those in 68 patients with good outcomes 1, 3, 5 and 7 days after the surgery as well as on discharge. The serum levels of CRP reached the top 1 day after the operation and then declined rapidly in the patients with poor outcomes. The multivariate analysis showed that the serum levels of CRP 1 and 3 days after the operation were significant related to poor outcomes in the patients with aSAH. The areas under the curve (AUV) for the serum levels of 1 and 3 days after the operation were 0.823 and 0.861, respectively. The serum level of CRP 3 days after the operation was positively related to the preoperative Hunt-Hess grades (r=0.42; P<0.05) and preoperative Fisher score (r=0.28; P<0.05) in the patients with aSAH. Conclusions It is suggested that the serum levels of CRP 1 and 3 days after the operation are of important value to predicting the prognoses in the patients with aSAH.