Effect of nimodipine combined with cerebrospinal fluid replacement by lumbar puncture on hemoglobin concentration, Toll-like receptor 4 expression levels and cerebral vasospasm in patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage
10.3760/cma.j.issn.1673-4165.2019.09.009
- VernacularTitle: 尼莫地平联合腰椎穿刺脑脊液置换对动脉瘤性蛛网膜下腔出血后脑血管痉挛患者血红蛋白浓度、Toll样受体4表达水平和脑血管痉挛的影响
- Author:
Jia FANG
1
;
Qiuyan DONG
2
;
Chenhao HU
1
;
Fangfang LIU
1
;
Jianning ZHANG
1
Author Information
1. Department of Neurosurgery, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China
2. Department of Characteristic Medicine, Beijing Armed Police Corps Hospital, Beijing 100027, China
- Publication Type:Clinical Trail
- Keywords:
Intracranial aneurysm;
Subarachnoid hemorrhage;
Vasospasm, intracranial;
Nimodipine;
Drainage;
Hemoglobins;
Toll-like receptor 4;
Treatment outcome
- From:
International Journal of Cerebrovascular Diseases
2019;27(9):685-690
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of nimodipine combined with cerebrospinal fluid replacement on hemoglobin concentration, Toll-like receptor 4 (TLR4) expression level and cerebral vasospasm (CVS) in patients with CVS after aneurysmal subarachnoid hemorrhage (aSAH).
Methods:One hundred and twenty patients with CVS after aSAH admitted to the Department of Neurosurgery, the Sixth Medical Center of PLA General Hospital from May 2013 to May 2015 were selected. They were randomly divided into control group and observation group (n=60 in each group). The control group received conventional treatment and nimodipine infusion after embolization of the aneurysms, and the observation group underwent cerebrospinal fluid replacement by lumbar puncture on this basis. The clinical efficacy, Glasgow Coma Scale (GCS) scores, hemoglobin concentration and TLR4 expression levels before and after treatment, and adverse reactions were compared between the two groups.
Results:One month after treatment, the improvement rate of vasospasm in the observation group was significantly higher than that in the control group (86.7% vs. 60.0%; χ2=9.590, P=0.002). Three months after the treatment, the good rate of clinical outcome (the modified Rankin Scale score 0-2) was significantly higher than that of the control group (88.3% vs. 58.3%; χ2 =13.807, P<0.001). Before treatment, there were no significant differences in hemoglobin concentration and TLR4 expression levels between the two groups; after treatment, the hemoglobin concentration and TLR4 expression levels of both groups were significantly reduced (P<0.05). Compared with the control group, the hemoglobin concentration (119.9±19.8 g/L vs. 137.6±17.8 g/L; t=3.270, P=0.001) and TLR4 expression level (2.5±1.2 vs. 4.5±1.5; t=8.060, P<0.001) in the observation group decreased more significantly. Multivariate logistic regression analysis showed that hypertension (odds ratio [OR] 5.19, 95% confidence interval [CI] 2.31-6.71), hyperlipidemia (OR 2.70, 95% CI 1.93-4.86), previous history of stroke or transient ischemic attack (OR 6.29, 95% CI 3.23-7.32), smoking (OR 4.80, 95% CI 2.18-6.19), and the TLR4 expression level before treatment (OR 3.28, 95% CI 2.87-6.93) were independently correlated with the lack of improvement in CVS, and cerebrospinal fluid replacement was independently correlated with CVS improvement (OR 0.40, 95% CI 0.14-0.89). There was no significant difference in the incidence of adverse reactions such as blood pressure drop, obstructive hydrocephalus and gastrointestinal hemorrhage between the observation group and the control group, but the incidence of delayed CVS (13.3% vs. 36.7%; χ2=7.510, P=0.006) and secondary cerebral infarction (8.3% vs. 31.7%; χ2=8.800, P=0.003) in the observation group were significantly lower than those of the observation group.
Conclusion:Nimodipine infusion combined with cerebrospinal fluid replacement by lumbar puncture affected the hemoglobin concentration and TLR4 expression levels, improved the CVS improvement rate, and significantly improved the clinical outcome in patients with CVS after aSAH.
