[1]孟发财,郭宝瑞,李 英.动脉瘤性蛛网膜下腔出血患者血清铁离子、水通道蛋白4水平与术后脑积水形成关系研究[J].陕西医学杂志,2025,54(2):222-226.[doi:DOI:10.3969/j.issn.1000-7377.2025.02.016]
　MENG Facai,GUO Baorui,LI Ying.Relationship between serum iron ions and aquaporin 4 levels in patients with aneurysmal subarachnoid hemorrhage and the formation of postoperative hydrocephalus[J].,2025,54(2):222-226.[doi:DOI:10.3969/j.issn.1000-7377.2025.02.016]
点击复制

动脉瘤性蛛网膜下腔出血患者血清铁离子、水通道蛋白4水平与术后脑积水形成关系研究
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
54
期数:
2025年2期
页码:
222-226
栏目:
临床研究
出版日期:
2025-02-05

文章信息/Info

Title:
Relationship between serum iron ions and aquaporin 4 levels in patients with aneurysmal subarachnoid hemorrhage and the formation of postoperative hydrocephalus
作者:
孟发财1; 郭宝瑞1; 李 英2
(1.陕西省人民医院神经外科,陕西 西安 710068; 2.陕西省康复医院检验科,陕西 西安 710065)
Author(s):
MENG Facai1; GUO Baorui1; LI Ying2
(1.Department of Neurosurgery,Shaanxi Provincial People's Hospital,Xi'an 710068,China; 2.Department of Clinical Laboratory,Shaanxi Kangfu Hospital,Xi'an 710065,China)
关键词:
动脉瘤性蛛网膜下腔出血;  铁离子;  水通道蛋白4;  脑积水;  血管内介入栓塞术
Keywords:
Aneurysmal subarachnoid hemorrhage;  Iron ions;  Aquaporin 4;  Hydrocephalus;  Endovascular embolization
分类号:
R 743.35
DOI:
DOI:10.3969/j.issn.1000-7377.2025.02.016
文献标志码:
A
摘要:
目的:探讨动脉瘤性蛛网膜下腔出血(aSAH)患者血清铁离子、水通道蛋白4(AQP4)水平与术后脑积水形成的关系。方法:选取接受血管内介入栓塞术的aSAH患者150例,根据术后1个月是否形成脑积水将患者分为脑积水组(43例)和非脑积水组(107例)。比较两组临床资料及不同时间血清铁离子、AQP4水平。采用Logistic回归分析aSAH患者术后发生脑积水影响因素。绘制受试者工作特征(ROC)曲线分析围手术期血清铁离子、AQP4水平对aSAH患者术后发生脑积水的预测价值。采用交互作用系数γ分析血清铁离子、AQP4的交互作用对aSAH患者脑积水形成的影响。结果:脑积水组术前格拉斯哥昏迷量表(GCS)评分低于非脑积水组,颅内血肿清除术治疗比例高于非脑积水组(均P<0.05)。脑积水组术后3、7 d血清铁离子、AQP4水平高于非脑积水组(均P<0.05)。术前GCS评分、颅内血肿清除术治疗、术后3 d血清铁离子、术后7 d血清铁离子、术后3 d血清AQP4、术后7 d血清AQP4为aSAH患者术后发生脑积水的独立影响因素(均P<0.05)。术后3、7 d血清铁离子和AQP4联合预测aSAH患者术后发生脑积水的曲线下面积(AUC)大于两者术后3、7 d单独预测的AUC(均P<0.05)。铁离子高水平与AQP4高水平在aSAH患者脑积水形成中呈正向交互作用,为次相乘模型。结论:aSAH继发脑积水患者术后血清铁离子、AQP4水平升高,是患者术后发生脑积水的独立影响因素,对脑积水形成具有一定预测效能,两者同时高水平表达在脑积水形成中呈正向交互作用,可增加脑积水形成风险。
Abstract:
Objective:To explore the relationship between serum iron ions and aquaporin 4(AQP4)levels in patients with aneurysmal subarachnoid hemorrhage(aSAH)and the formation of postoperative hydrocephalus.Methods:A total of 150 patients with aSAH who underwent intravascular interventional embolization were selected and divided into a hydrocephalus group(43 cases)and a non-hydrocephalus group(107 cases)based on whether hydrocephalus developed one month after surgery.The clinical data and serum iron and AQP4 levels at different times were compared between the two groups.Logistic regression analysis was used to analyze the influencing factors of hydrocephalus in patients with aSAH after surgery.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of perioperative serum iron and AQP4 levels for the occurrence of hydrocephalus in patients with aSAH.The interaction coefficient γ was used to analyze the effect of the interaction between serum iron ions and AQP4 on the formation of hydrocephalus in patients with aSAH.Results:The preoperative Glasgow Coma Scale(GCS)score in the hydrocephalus group was lower than that in the non-hydrocephalus group,and the proportion of patients treated with intracranial hematoma evacuation surgery was higher in the hydrocephalus group than in the non-hydrocephalus group(all P<0.05).The levels of serum iron ions and AQP4 at 3 and 7 days after surgery in the hydrocephalus group were higher than those in the non-hydrocephalus group(all P<0.05).Preoperative GCS score,intracranial hematoma evacuation surgery,serum iron ions at 3 days postoperatively,serum iron ions at 7 days postoperatively,serum AQP4 at 3 days postoperatively and serum AQP4 at 7 days postoperatively were independent influencing factors for the occurrence of postoperative hydrocephalus in patients with aSAH(all P<0.05).The AUC for the combined prediction of serum iron ions and AQP4 at 3 and 7 days postoperatively for the occurrence of postoperative hydrocephalus in patients with aSAH was greater than that of individual predictions at 3 and 7 days postoperatively(all P<0.05).High levels of iron ions and high levels of AQP4 showed a positive interactive effect in the formation of hydrocephalus in patients with aSAH,which was a sub-multiplicative model.Conclusion:Elevated levels of serum iron ions and AQP4 in patients with aSAH who developed secondary hydrocephalus are independent influencing factors for the occurrence of postoperative hydrocephalus,have certain predictive efficacy for the formation of hydrocephalus,and their simultaneous high-level expression shows a positive interactive effect in the formation of hydrocephalus,which can increase the risk of hydrocephalus formation.

参考文献/References:

[1] NEIFERT S N,CHAPMAN E K,MARTINI M L,et al.Aneurysmal subarachnoid hemorrhage:The last decade[J].Transl Stroke Res,2021,12(3):428-446.
[2] HOH B L,KO N U,AMIN-HANJANI S,et al.2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage:A guideline from the American Heart Association/American Stroke Association[J].Stroke,2023,54(7):e314-e370.
[3] ADDIS A,BAGGIANI M,CITERIO G.Intracranial pressure monitoring and management in aneurysmal subarachnoid hemorrhage[J].Neurocrit Care,2023,39(1):59-69.
[4] GONG C,SUN M S,LENG R,et al.Endovascular embolization of visceral artery aneurysm:A retrospective study[J].Sci Rep,2023,13(1):6936.
[5] KUO L T,HUANG A P.The pathogenesis of hydrocephalus following aneurysmal subarachnoid hemorrhage[J].Int J Mol Sci,2021,22(9):5050.
[6] 唐剑,陈双华,何凌.骨髓间充质干细胞来源外泌体对大鼠脊髓损伤的改善作用及对脊髓组织胞浆型磷脂酶A2、水通道蛋白4和水通道蛋白9的影响实验研究[J].陕西医学杂志,2023,52(12):1654-1659.
[7] KITCHEN P,SALMAN M M,HALSEY A M,et al.Targeting aquaporin-4 subcellular localization to treat central nervous system edema[J].Cell,2020,181(4):784-799.
[8] ZHAO X,KRUZEL M,ARONOWSKI J.Lactoferrin and hematoma detoxification after intracerebral hemorrhage[J].Biochem Cell Biol,2021,99(1):97-101.
[9] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组,中华医学会神经病学分会神经血管介入协作组.中国蛛网膜下腔出血诊治指南2019[J].中华神经科杂志,2019,52(12):1006-1021.
[10] 黄永健,麦玲,罗婷,等.颅内动脉瘤血管内介入术后慢性脑积水患者血清CCCK-18、Netrin-1、HPA水平变化及意义[J].山东医药,2023,63(10):31-35.
[11] 伍学斌,曾胜田,彭远强,等.神经内镜下第三脑室底造瘘术联合脑室-腹腔分流术治疗高血压脑出血术后慢性正常压力脑积水的效果分析[J].中国脑血管病杂志,2023,20(6):398-404.
[12] 李泽新,张贝贝.血清缺氧诱导因子-1α、前列腺素E2水平与动脉瘤性蛛网膜下腔出血关系及对脑血管痉挛的预测价值[J].陕西医学杂志,2023,52(2):141-144,191.
[13] 袁晓东,吴过,熊建平,等.动脉瘤性蛛网膜下腔出血后慢性脑积水形成的相关因素分析[J].实用心脑肺血管病杂志,2015(5):59-61.
[14] CZORLICH P,SCHWEINGRUBER N,GÖTTSCHE J,et al.Acute low-pressure hydrocephalus in aneurysmal subarachnoid hemorrhage[J].Neurosurg Focus,2023,54(4):e5.
[15] ZHENG R Z,XU Z,WANG Z,et al.Clinical characteristics of and treatment strategy for hydrocephalus in patients with severe disorders of consciousness[J].J Neurotrauma,2023,40(13-14):1402-1414.
[16] 刘宙.成人脑室内出血并发慢性脑积水的研究进展[J].中国微侵袭神经外科杂志,2020,25(1):46-48.
[17] 曹晓璐,揣春阳,周梦,等.动脉瘤性蛛网膜下腔出血介入栓塞术后并发脑积水的危险因素分析[J].中国临床实用医学,2024,15(1):23-28.
[18] DI-RUSSO P,DI-CARLO D T,LUTENBERG A,et al.Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage[J].J Neurosurg Sci,2020,64(2):181-189.
[19] ZOLLER H,WOLF M,BLUMENSTEIN I,et al.Hypophosphataemia following ferric derisomaltose and ferric carboxymaltose in patients with iron deficiency anaemia due to inflammatory bowel disease(PHOSPHARE-IBD):A randomised clinical trial[J].Gut,2023,72(4):644-653.
[20] LI C Q,XING Y,ZHANG Y Q,et al.Neutrophil extracellular traps exacerbate ischemic brain damage[J].Mol Neurobiol,2022,59(1):643-656.
[21] 姚亚妮,罗鑫宇,冯婷婷,等.帕金森病患者外周铁代谢与炎症因子、临床症状及病情严重程度的相关性研究[J].新疆医科大学学报,2023,46(12):1575-1579.
[22] YANG L Y,CHEN Y R,LEE J E,et al.Dental pulp stem cell-derived conditioned medium alleviates subarachnoid hemorrhage-induced microcirculation impairment by promoting M2 microglia polarization and reducing astrocyte swelling[J].Transl Stroke Res,2023,14(5):688-703.
[23] LAPSHINA K V,EKIMOVA I V.Aquaporin-4 and Parkinson's disease[J].Int J Mol Sci,2024,25(3):1672.
[24] 汪文兵,陈后勤,徐钧,等.血清AQP4、GFAP联合检测对急性缺血性脑卒中患者静脉溶栓后出血性转化的预测价值[J].临床误诊误治,2022,35(5):102-105.
[25] SALMAN M M,KITCHEN P,HALSEY A,et al.Emerging roles for dynamic aquaporin-4 subcellular relocalization in CNS water homeostasis[J].Brain,2022,145(1):64-75.
[26] LI Y,NAN D,LIU R,et al.Aquaporin 4 mediates the effect of iron overload on hydrocephalus after intraventricular hemorrhage[J].Neurocrit Care,2024,40(1):225-236.
[27] 刘胜,李明昌.蛛网膜下腔出血的脑损伤机制及相关生物标志物研究进展[J].国际神经病学神经外科学杂志,2023,50(3):51-59.

相似文献/References:

[1]孙 建,刘新宇△.三七总皂苷胶囊治疗糖尿病周围神经病变临床疗效及机制研究*[J].陕西医学杂志,2020,49(11):1496.[doi:DOI:10.3969/j.issn.1000-7377.2020.11.033]
　SUN Jian,LIU Xinyu..Clinical efficacy and mechanism of panax notoginsen saponins capsule in the treatment of diabetic peripheral neuropathy[J].,2020,49(2):1496.[doi:DOI:10.3969/j.issn.1000-7377.2020.11.033]
[2]黎 莎,张占伟,胡 烨,等.术前格拉斯哥昏迷量表评分、白蛋白与纤维蛋白原比值与动脉瘤性蛛网膜下腔出血患者术后转归关系研究[J].陕西医学杂志,2025,54(2):209.[doi:DOI:10.3969/j.issn.1000-7377.2025.02.013]
　LI Sha,ZHANG Zhanwei,HU Ye,et al.Relationship between preoperative GCS scores,AFR and postoperative outcomes in patients with aneurysmal subarachnoid hemorrhage[J].,2025,54(2):209.[doi:DOI:10.3969/j.issn.1000-7377.2025.02.013]

备注/Memo

备注/Memo:
[基金项目]陕西省自然科学基础研究计划项目(2024JC-YBQN-0952)
更新日期/Last Update: 2025-02-04