Changes in vascular endothelial function parameters and their correlation with prognosis in patients with aSAH after intracranial aneurysm embolization
10.3760/cma.j.cn115396-20241018-00319
- VernacularTitle:aSAH患者颅内动脉瘤栓塞术后血管内皮功能参数变化及其与预后的相关性
- Author:
Fei QI
1
;
Zhifeng BAI
;
Jing WANG
Author Information
1. 北京丰台右安门医院神经介入科，北京 100069
- Keywords:
Subarachnoid hemorrhage;
Intracranial aneurysm;
Embolism;
Prognosis;
Vascular endothelial function parameters;
Neurological function
- From:
International Journal of Surgery
2025;52(4):256-266
- CountryChina
- Language:Chinese
-
Abstract:
Objective:In order to explore the changes of vascular endothelial function parameters and their correlation with prognosis in patients with aneurysmal subarachnoid hemorrhage (aSAH) after intracranial aneurysm embolization.Methods:A retrospective cohort study was conducted to select 126 patients diagnosed with aSAH in the Department of Neurointerventional of Beijing Fengtai You′anmen Hospital from August 2021 to August 2023. There were 69 males and 57 females, with an age of (52.27±3.34) years, aged 45-62 years. The patients were grouped according to the glasgow prognostic score (GOS) at three months after the prognosis of intracranial aneurysm embolization, including 81 cases in the good prognosis group and 45 cases in the poor prognosis group. The main indexes were calcitonin gene-related peptide (CGRP), endothelin-1, vascular endothelial growth factor (VEGF), S100β, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), and the secondary indicators were the Hunt and Hess Scale (Hunt-Hess), the National Institutes of Health Stroke Scale (NIHSS), and the Glasgow coma scale (Glasgow), coma scale (GCS), Immunoglobulin A (IgA), Immunoglobulin M (IgM) and Immunoglobulin G (IgG). A generalized mixed-effect model was established to analyze the effect of vascular endothelial function on adverse prognosis, and ROC curve was used to analyze the impact of changes in vascular endothelial function on adverse prognosis. The restriction cubic spline model was used to analyze the dose-response relationship between the changes of postoperative endothelial function indexes and the poor prognosis of intracranial aneurysm embolization in aSAH patients. The Log-rank test was used for Kaplan-Meiker survival analysis. The mean ± standard deviation ( ± s) was used for the normally distributed continuous data, and the independent samples t-test was used for comparison between groups. The chi-square test was used for comparison of enumerated data between groups. Results:There were statistically significant levels of Hunt-Hess, NIHSS, GCS, cerebral vasospasm (CVS) and shunt dependence in the two groups ( P<0.05), and the CGRP of the two groups increased significantly after surgery, and after 2 weeks of treatment, the CGRP of the patients in the good prognosis group was (58.36±3.84) pg/mL, which was significantly higher than that in the poor prognosis group (49.36±4.55) pg/mL. After 2 weeks of treatment, endothelin-1 and VEGF in the good prognosis group were (62.74±27.46) pg/mL and (110.55±34.82) ng/mL, respectively, which were significantly lower than those in the poor prognosis group (92.64±28.44) pg/mL and (145.45±32.19) ng/mL, respectively, and the differences between the two groups were statistically significant ( P<0.05), The neurological indexes of the two groups were significantly decreased, and the S100β, GFAP and NSE in the good prognosis group were (6.75±2.73) ng/L, (6.85±1.54) mg/L and (8.24±4.51) ng/L after 2 weeks of treatment, which were significantly lower than those in the poor prognosis group (8.76±2.44) ng/L, (8.63±1.63) mg/L and (13.84±3.19) ng/L, respectively. There was a statistically significant difference between the two groups ( P<0.05).Before and after the correction factors, the vascular endothelial function indexes of aSAH patients at different time points were significantly correlated with their neurological function indicators. The 14-day change of vascular endothelial function index was significantly correlated with poor prognosis ( P<0.05). The results of subgroup analysis showed that vascular endothelial function indicators and poor prognosis were statistically significant in the range of Hunt-Hess≥2 points, NIHSS≥14 points, GCS≥11 points, CVS, shunt dependence, S100β<10.81 ng/L, GFAP≥9.93 mg/L, NSE≥29.00 ng/L, IgA<2.46 g/L, IgM≥1.70 g/L, and IgG<11.50 g/L ( P<0.05). The results of ROC curve showed that the area under the curve (AUC) of CGRP, endothelin-1 and VEGF were 0.869, 0.834 and 0.874, respectively. There was a nonlinear dose-response relationship between CGRP, endothelin-1 and VEGF and the poor prognosis of intracranial aneurysm embolization in aSAH patients. Conclusion:The vascular endothelial function of aSAH patients with aSAH can be improved after intracranial aneurysm embolization, and it is related to neurological function, and the better the endothelial function index, the higher the probability.
