急性期胰岛素样生长因子-1对动脉瘤性蛛网膜下腔出血院内并发症及短期预后的预测作用

Predictive Value of Insulin like Growth Factor-1 for Inhospital Complications and Short-term Outcome after Aneurysmal Subarachnoid Hemorrhage

目的探讨胰岛素样生长因子-1(insulin like growth factor-1,IGF-1)水平对动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者院内并发症及出院时临床预后的预测价值。方法连续入组发病72 h内的aSAH患者及健康对照。在动脉瘤闭塞术前采集血样,测定血浆IGF-1水平。对患者基本信息,神经内分泌因子、院内并发症及结局进行分析,用Logistic回归确定院内并发症及出院时预后不良(mRS评分>2分)的预测因素,计算预测因素的受试者工作特征曲线下面积。结果共入组118例aSAH患者和122例健康对照者。aSAH患者血浆IGF-1水平较健康对照低[69.00(50.98,93.85)ng/mL vs 81.05(69.40,102.78)ng/mL,P <0.0001]。37例(31.4%)患者出院时预后不良。IGF-1浓度越低(OR 0.971,95%CI 0.946~0.996,P =0.0262)、入院时Hunt-Hess分级3~5级(OR 4.995,95%CI 1.331~18.747,P =0.0007)、住院期间发生迟发型脑缺血(OR 46.100,95%CI11.152~190.566,P <0.0001)及脑积水(OR 7.768,95%CI 1.088~55.463,P =0.0284)的患者预后不良风险增高。IGF-1与Hunt-Hess分级、迟发型脑缺血的预测价值基本相同(P >0.05)。71例(60.2%)患者住院期间发生至少1种并发症。仅有入院时I GF-1浓度(OR 0.984,95%CI 0.973~0.996,P =0.0082)对院内并发症有预测价值。结论 aSAH急性期患者血浆IGF-1浓度越低,住院期间并发症发生率越高,出院时功能预后越差。

Objective To investigate the predictive value of insulin like growth factor-1(IGF-1) for inhospital complications and short-term clinical outcomes after aneurysmal subarachnoid hemorrhage(aSAH).Methods Patients who were diagnosed as aSAH and within 72 h after symptom onset were selected. Upon admission and before aneurysm occlusion, plasma IGF-1 levels were measured.Patients with aneurysmal subarachnoid hemorrhage characteristics, perioperative complications and outcomes at discharge were analyzed. Logistic regression analyse was performed to identify independent factors associated with the poor clinical outcomes(mRS>2) and complications in hospital.Results 118 consecutive aSAH patients and 122 health controls were evaluated. The IGF-1 levels of aSAH patients were lower than that of health controls [69.00(50.98, 93.85) ng/mL vs 81.05(69.40, 102.78) ng/mL, P<0.0001]. A total of 37 patients with aSAH(31.4%) had poor outcomes at discharge. More lower IGF-1 level(OR 0.971, 95%CI 0.946-0.996, P=0.0262), higher Hunt-Hess scales(III-V, OR 4.995, 95%CI 1.331-18.747, P=0.0007), delayed cerebral ischemia(OR 46.100,95%CI 11.152-190.566, P<0.0001) and hydrocephalus(OR 7.768, 95%CI 1.088-55.463, P=0.0284)in hospital were associated with poor clinical outcomes at discharge. The AUC of the IGF-1 level was similar to that of the Hunt-Hess scales and delayed cerebral ischemia for the prediction of poor outcome at discharge(P>0.05). A total of 71 aSAH patients(60.2%) had at least one complication.Only the IGF-1 level on admission(OR 0.984, 95%CI 0.973-0.996, P =0.0082) can predict complications in hospital.Conclusions Lower IGF-1 levels at acute phase is the predictive factor for inhospital complications and short-term poor outcome in patients with acute aSAH.