The Impact Of Homocysteine And Bilirubin On Cerebral Vasospasm And Prognosis After Intracranial Aneurysm Clipped

Background:Intracranial aneurysm has been one of the most serious disease which threaten human health significantly by the high mortality and disability if it ruptures in the past years,and the incidence of this disease has been the third in cerebrovascular disease.With the progress of the treatment and the perioperative management recentl years,the fatality and disability rate showed a obvious trend towards a decrease.However,the mechanism of cerebral vasospasm,one of the key factors influencing the prognosis,is not very clear,The recent study found that age,hunt-hess grade,secondary bleeding,acute hydrocephalus,the size and location of aneurysms,smoke or hypertension and other factors influenced the cerebral vasospasm after subarachnoid hemorrhage.And in recent years homocysteine and bilirubin has been two key factors in cerebrovascular disease,only a few studys about homocysteine levels have an effect on cerebral vasospasm and prognosis,bilirubin oxidation products in the experiments in vivo or vitro are clearly one of the factors that can lead to cerebral vasospasm,but now still lacked of enough clinical research about the impact of homocysteine and bilirubin on cerebral vasospasm and prognosis after intracranial aneurysm clipped.Objective:Through the researches on the change of perioperative homocysteine and serum bilirubin level to discuss the cerebral vasospasm and prognosis,in order to has certain help with clinical treatment and perioperative management of the ruptured intracranial aneurysm patients.Methods:Collect the 176 patients of aneurysmal subarachnoid hemorrhage examined in the NO.2 hospital of Ji Lin University from March 2015 to July 2016,aging from 46-83 years old,record the perioperative homocysteine and serum bilirubin level,compare with the Incidence of cerebral vasospasm and prognosis in different levels,and compare with the statistics of the homocysteine and serum bilirubin level of 103 patients aging in 45-80 who are Physical Check-Ups in this hospital.Results:1.The homocysteine level in the aneurysmal subarachnoid hemorrhage patients was higher than that in the normal person(P<0.01).2.The serum homocysteine level was positively related with the incidence of cerebral vasospasm after aneurysm clipped(P<0.05).3.The prognosis after intracranial aneurysm clipped with hyperhomoeysteinemia was poorer than the normal ones(P<0.05).4.The perioperative serum bilirubin level of patients with intracranial aneurysm clipped like a parabolic variation,the peak around 1day after surgery(about 3-4days after subarachnoid hemorrhage).5.Perioperative serum bilirubin peak was positively correlated with the incidence of cerebral vasospasm(P<0.01).6.Prognosis of the patients with high perioperative serum bilirubin peak level was poorer than the ones with low level(P<0.05).7.The daily bilirubin level of patients with a history of ruptured intracranial aneurysm bleeding was lower than those of healthy people with the same age(P<0.01).8.Homocysteine levels had no obvious effect on perioperative serum bilirubin peak level with intracranial aneurysm clipped(P>0.05).Conclusions:1.The higher level of homocysteine and lower level of bilirubin level are risk factors for intracranial aneurysm occurred.2.The serum homocysteine level was positively related with the incidence of cerebral vasospasm after aneurysm clipped,hyperhomoeysteinemia is one of its risk factors.3.The perioperative bilirubin level of aneurysmal subarachnoid hemorrhage patients with a neurosurgical clipping liked a parabolic variation,the peak at about 1 to 2 days after the surgery,after the subarachnoid hemorrhage three to four days or so,High serum bilirubin level may be a risk factor for cerebral vasospasm occurred,also may be a symbol of coming or had been cerebral vasospasm.4.High homocysteine level and perioperative bilirubin level is aneurysmal subarachnoid hemorrhage risk factors of poor prognosis.