蛛网膜下腔出血患者脑脊液和血液乳酸、糖水平及其比值动态变化的临床意义

Levels of Lactate and Glucose in the Cerebrospinal Fluid and Blood of Subarachnoid Hemorrhage Patients,Dynamic Changes of Lactate-to-Glucose Ratio and Its Clinical Significance

目的探讨蛛网膜下腔出血(SAH)患者脑脊液乳酸(Csf-Lac)、脑脊液糖(Csf-Glu)和血乳酸(Blood-Lac)、血糖(Blood-Glu)水平及乳酸/糖比值之比(L/G.R)动态变化特点,及其与SAH后脑血管痉挛(CVS)的关系。方法以12例在神经内科或骨科住院的腰腿痛患者为对照组;发病后24 h内入院的SAH患者47例,根据SAH患者是否出现CVS分为CVS组(19例)和nCVS组(28例)。分析CVS组及nCVS组SAH患者第1、3、7、10、14天Csf-Lac、Csf-Glu和Blood-Lac、Blood-Glu水平动态变化及TCD(经颅多普勒)结果,计算每组患者L/G.R值。结果 47例SAH患者发生CVS 19例,其中SAH后1～2 d 4例,3～7 d 13例,8～10 d 2例。SAH组患者不同时间及对照组的Csf-Lac、Blood-Glu、L/G.R和动脉平均流速(VmMCA)水平比较,差异均有统计学意义(P<0.05)。3组受检者Csf-Lac、Blood-Glu、L/G.R和VmMCA水平比较,差异均有统计学意义(P<0.01);其中,CVS组与nCVS组上述指标比较,差异均有统计学意义(P<0.05);而3组Csf-glu、Blood-lac水平比较,差异无统计学意义(P>0.05)。结论 SAH患者CVS期间Blood-Glu、Csf-Lac和L/G.R增高,约14 d后L/G.R逐渐下降至正常,对SAH后预测CVS的发生有参考价值。

Objective To explore the dynamic changes of lactate,glucose levels and lactate-to-glucose ratio（L/G·R） in the cerebrospinal fluid（Csf） and blood of subarachnoid hemorrhage（SAH） patients and to analyze the correlations with cerebral vasospasm（CVS） secondary to SAH.Methods Twelve hospitalized patients with back or leg pain were enrolled as controls while 47 SAH patients admitted within 24 hours after onset were enrolled and classified according to the presence of neurological symptoms as the CVS group（n=19） and the nCVS group（n=28）.Csf and blood levels of lactate,glucose and transcranial doppler（TCD） results on day 1,3,7,10 and 14 in each group were analyzed,with L/G·R of Csf and blood were calculated.Results Nineteen patients developed CVS,4 on day 1～2 after SAH,13 on day 3～7,2 on day 8～10.The levels of Csf-Lac,blood-Glu,L/G·R and VmMCA increased significantly in the SAH groups at different time points compared with the control group（P0.05）;the above indicators were statistically different among the CVS,nCVS and control group（P0.01）;the differences between the CVS and the nCVS group were statistically significant（P0.05）,while levels of Csf glucose and blood lactate were not significantly different among the three groups（P0.05）.Conclusion Csf lactate,blood glucose and the corresponding L/G·R of Csf and blood rise during CVS and fall back to normal on the 14th day after SAH.Biochemical indices of Csf and blood are of great value in predicting the onset of CVS secondary to SAH.