经颅多普勒超声联合血清乳酸脱氢酶预测蛛网膜下腔出血患者迟发性脑缺血的价值

The value of transcranial Doppler ultrasound combined with serum lactate dehydrogenase in predicting delayed cerebral ischemia in patients with subarachnoid hemorrhage.

目的探讨经颅多普勒超声(TCD)联合血清乳酸脱氢酶(LDH)对蛛网膜下腔出血(SAH)致迟发性脑缺血(DCI)的早期预警的作用及意义。方法回顾性选取2017年3月至2019年10月长江大学附属仙桃市第一人民医院收治的299例动脉瘤性蛛网膜下腔出血(aSAH)患者进行研究。根据是否并发DCI将其分为未并发DCI组(n=216)、并发DCI组(n=83)。并行TCD检查,记录大脑中动脉平均血流速度(MBFV)及LI指数(Lindegard指数)和血管搏动指数(PI);测定血清LDH表达水平;应用多因素Logistic分析影响aSAH后DCI发生的因素,并绘制受试者工作特征(ROC)曲线评估MBFV、LI指数、血清LDH及联合检测对aSAH患者并发DCI的预测价值。结果并发DCI组与未并发DCI组低钠血症、低血红蛋白、Hunt-Hess分级、Fisher分级及动脉瘤位置比较差异均有统计学意义(P<0.05)。并发DCI组与未并发DCI组入院后次日、发病后3、7、10及14 d时MBFV、LI指数及血清LDH水平存在组间和时间交互作用(P<0.05);而两组PI指数仅时间比较差异有统计学意义(P<0.05),组间和时间不存在交互作用(P>0.05)。Logistic回归分析显示,Fisher分级、MBFV、LI指数、血清LDH均是影响aSAH后DCI发生的危险因素(P<0.05);ROC结果显示,MBFV、LI指数、血清LDH及3者联合预测aSAH患者并发DCI的曲线下面积(AUC)分别为0.849、0.805、0.846、0.955,3者联合检测的结果明显高于单项指标结果(P<0.05)。结论aSAH并发DCI患者MBFV、LI指数及血清LDH均较高,3者联合可能为临床早期预测aSAH患者并发DCI提供参考依据。

Objective To explore the role and significance of transcranial Doppler ultrasound(TCD)combined with serum lactate dehydrogenase(LDH)in the early warning of delayed cerebral ischemia(DCI)in subarachnoid hemorrhage(SAH).Methods A total of 299 patients with aneurysmal subarachnoid hemorrhage(aSAH)in Xiantao First People's Hospital Affiliated to Yangtzeu University from March 2017 to October 2019 were retrospectively selected.According to whether there were concurrent DCI,the patients were divided into non-concurrent DCI group(n=216)and concurrent DCI group(n=83).TCD was performed to record the mean blood flow velocity(MBFV),LI index(Lindegard index)and vascular pulsatility index(PI)of the middle cerebral artery;the expression level of serum LDH was measured;multivariate Logistic analysis was used to analyze the factors affecting the occurrence of DCI after aSAH,the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of MBFV,LI index,serum LDH and the combination for DCI in patients with aSAH.Results There were statistically significant differences in hyponatremia,low hemoglobin,Hunt-Hess grade,Fisher grade and aneurysm location between the concurrent DCI group and the non-concurrent DCI group(P<0.05);there was an interaction between groups and time among MBFV,LI index and serum LDH level in the concurrent DCI group and the non-concurrent DCI group at the next day after admission,3,7,10 and 14 d after the onset of disease(P<0.05).However,the difference in PI index between the two groups was statistically significant only in time(P<0.05),and there was no interaction between the groups and time(P>0.05).Logistic regression analysis showed that Fisher classification,MBFV,LI index,and serum LDH were all risk factors affecting the occurrence of DCI after aSAH(P<0.05);ROC results showed that the area under the curve(AUC)of MBFV,LI index,serum LDH and the the combination to predict DCI in aSAH patients was 0.849,0.805,0.846,0.955,respectively,the combined test results were significantly higher than the single index results(P<0.05).Conclusion MBFV,LI index and serum LDH are higher in patients with aSAH complicated with DCI,and the combination of the three may provide a reference for early clinical prediction of DCI in patients with aSAH.