Abstract: Objective  To explore the relationship and predictive value of imaging changes of subarachnoid hemorrhage, the degree of consciousness disturbance and cerebrocardiac syndrome secondary to subarachnoid hemorrhage.
Methods  Patients with subarachnoid hemorrhage aged 18-70 years who were diagnosed and treated in the emergency room of Beijing Tiantan Hospital, Capital Medical University from May 2020 to May 2022 were retrospectively included. Skull CT was performed immediately after admission to evaluate the modified Fisher scale in all cases, and GCS were performed on the day of hemorrhage. Ecg and blood samples were collected for cardiac troponin I (cTNI) and B-type natriuretic peptide (BNP) detection on the 1st, 3rd, 5th, 7th and 14th day after admission, and echocardiography was completed on the 1st and 14th day after admission. Left ventricular ejection fraction (LVEF) was measured. Average values of cTNI, BNP and LVEF were calculated for multiple times as analysis data. When the data of all cases were analyzed, they were divided into cerebrocardiac syndrome group and non-cerebrocardiac syndrome group according to the presence or absence of cerebrocardiac syndrome.
Results  A total of 261 patients were included, including 146 (55.9%) in the cerebrocardiac syndrome group and 115 (44.1%) in the non-cerebrocardiac syndrome group. The median cTNI [3.214 (1.125-6.101) ng/mL vs. 0.009(0.005-0.015) ng/mL, P=0.014] and BNP [589.12 (426.19-695.42) pg/mL vs. 78.47 (55.25-102.34) pg/mL, P=0.009] were higher in the group with cerebrocardiac syndrome than in the group with non-cerebrocardiac syndrome. The mean value of LVEF (42.57%±3.52% vs. 53.24%±3.14%, P=0.012), GCS score (9.12±2.26 vs. 12.85±1.58, P=0.038), modified Fisher grade (2.84±0.72 vs. 1.75±0.34, P=0.045) was lower than that of the non-cerebrocardiac syndrome group. GCS score was negatively correlated with mean cTNI (r=-0.458, P<0.001) and mean BNP (r=-0.724, P<0.001), and positively correlated with mean LVEF (r=0.687, P<0.001). The modified Fisher grading was positively correlated with the mean of cTNI (r=0.542, P<0.001) and BNP (r=0.429, P<0.001), and negatively correlated with the mean of LVEF (r=-0.721, P<0.001). The ROC curve of the diagnostic value of the GCS score for the cerebrocardiac syndrome secondary to subarachnoid hemorrhage was 0.813 (95%CI 0.728-0.898), and the optimal cut-off value was 0.628 (at this time, the sensitivity was 68.3%, the specificity was 94.6%). The AUC of the modified Fisher classification was 0.820 (95%CI 0.730-0.910), and the optimal cut-off was 0.542 (sensitivity was 92.1%, specificity was 62.2%).
Conclusions  The lower the GCS score of subarachnoid hemorrhage, the higher the probability of secondary cerebrocardiac syndrome. The higher the modified Fisher grade, the greater the likelihood of secondary cerebrocardiac syndrome. The modified Fisher scale and GCS score may predict the cerebrocardiac syndrome timely and accurately.

Key words: Modified Fisher score; Glasgow coma scale score; Subarachnoid hemorrhage; Cerebrocardiac syndrome

摘要： 目的 探索蛛网膜下腔出血影像学改变及意识障碍程度与蛛网膜下腔出血继发脑心综合征的关系及预测价值。
方法 回顾性纳入2020年5月—2022年5月在首都医科大学附属北京天坛医院急诊抢救室诊治的18～70岁蛛网膜下腔出血患者。所有病例来诊后即时完成头颅CT检查评估改良Fisher分级，出血当天同时采用GCS进行评估。入院第1、3、5、7、14天均采集心电图及血标本检测心肌肌钙蛋白I（cardiac troponin I，cTNI）、B型利钠肽（B-type natriuretic peptide，BNP），入院后第1、14天完成超声心动图检查，测量左室射血分数（left ventricular ejection fraction，LVEF），cTNI、BNP、LVEF计算多次平均值作为分析数据。根据有无脑心综合征分为脑心综合征组及非脑心综合征组进行数据分析。 
结果 共纳入261例患者，其中脑心综合征组146例（55.9%），非脑心综合征组115例（44.1%）。脑心综合征组的中位cTNI[3.214（1.125～6.101）ng/mL vs. 0.009（0.005～0.015）ng/mL，P=0.014]、中位BNP水平[589.12（426.19～695.42）pg/mL vs. 78.47（55.25～102.34）pg/mL，P=0.009]均高于非脑心综合征组。脑心综合征组平均LVEF（42.57%±3.52% vs. 53.24%±3.14%，P=0.012）、平均GCS评分[（9.12±2.26）分 vs.（12.85±1.58）分，P=0.038]、改良Fisher分级[（2.84±0.72）级 vs.（1.75±0.34）级，P=0.045]均低于非脑心综合征组。GCS评分与cTNI水平（r=﹣0.458，P＜0.001）及BNP水平（r=﹣0.724，
P＜0.001）呈负相关，与LVEF呈正相关（r=0.687，P＜0.001）。改良Fisher分级与cTNI水平（r=0.542，
P＜0.001）及BNP水平（r=0.429，P＜0.001）均呈正相关，与LVEF呈负相关（r=﹣0.721，
P＜0.001）。GCS评分对蛛网膜下腔出血继发脑心综合征诊断价值的ROC曲线对应的AUC值为0.813（95%CI 0.728～0.898），最佳截断值为0.628（此时灵敏度为68.3%，特异度为94.6%）；改良Fisher分级对应的AUC值为0.820（95%CI 0.730～0.910），最佳截断值为0.542（此时灵敏度为92.1%，特异度为62.2%）。
结论 蛛网膜下腔出血者GCS评分越低，继发脑心综合征可能性越大；改良Fisher分级越高，继发脑心综合征可能性也越大。改良Fisher分级及GCS评分能及时早期预判脑心综合征。

关键词: 改良Fisher分级; 格拉斯哥昏迷量表评分; 蛛网膜下腔出血; 脑心综合征