Актуальность. Аневризматическое субарахноидальное кровоизлияние является распространенным и серьезным заболеванием, которое может приводить к летальным последствиям. Цель исследования: изучить динамику натриемии в контексте ее клинико-патогенетического значения у пациентов с субарахноидальным кровоизлиянием. Материалы и методы. Обследовано 87 пациентов с субарахноидальным кровоизлиянием, из них 38 (43,68 %) — с изолированным субарахноидальным кровоизлиянием, 14 (16,09 %) — с субарахноидально-паренхиматозным, 29 (33,33 %) — с субарахноидально-желудочковым, 6 (6,9 %) — с субарахноидально-паренхиматозно-желудочковым кровоизлиянием, общее количество смешанных кровоизлияний составляло 56,32 %. Для проведения полного ангиографического исследования использовали ангиографический комплекс AXIOM Artis MP «Siemens». Результаты. Исследование SIADH-синдрома (синдром неадекватной секреции антидиуретического гормона) с развитием гипонатриемии у пациентов с субарахноидальным кровоизлиянием нетравматического генеза свидетельствует о тесной ассоциации между выраженностью нарушений осмотического гомеостаза и тяжестью клинического течения субарахноидального кровоизлияния согласно модифицированной шкале Fisher, шкале WFNS, шкале Нunt & Неss, шкале результатов GOSE (Glasgow Outcome Scale Extended) и обобщающей классификационной шкале для оценки прогноза исхода субарахноидального кровоизлияния (Ogilvy C.S. et Carter B.S.). У лиц с гипонатриемией на фоне субарахноидального кровоизлияния сопряженность сывороточного уровня натрия и показателя сывороточного уровня копептина адекватно и достоверно аппроксимируется уравнением регрессии логарифмического характера (по основанию 10), при значениях копептина более 0,70 нг/мл в более чем 50 % случаев регистрировалась натриемия средней тяжести. Выводы. Была обнаружена достоверная тесная взаимосвязь между уровнем данного пептида с нейроэндокринными свойствами — копептина и нарушением осмотического гомеостаза ионов натрия на фоне субарахноидального кровоизлияния с различной тяжестью клинического течения.

Objective – to evaluate of diagnostic informativeness of сopeptin serum values in determining the risk of complications in patients with subarachnoid hemorrhage.Materials and methods. A prospective cohort study of 82 patients (40 men and 42 women) with spontaneous (non-traumatic) subarachnoid hemorrhage (SAH) from the age of 23 to 72 years (average age – (49,6 ±1,3) year) was conducted.Results. Complications were recorded in 31 (74.20 %) patients with a serum level of copeptin ≥ 0.605 ng/ml on the third day of the SAH, which was in 9.49 times higher (95 % CI 3.60–24.80, р ˂0.0001) than in patients with a serum level of copeptin < 0.605 ng/ml. When determining the cumulative risk of developing complications of SAH, the values ​​of positive and negative predictive values ​​of serum levels of copeptin on third day of SAH were 74.19 % and 92.20 % respectively, the accuracy of prediction (the sum of correctly classified observations) was 85.39 %.Conclusions. ROC-analysis suggests that the serum level of copeptin on third day of SAH ≥ 0.605 ng/ml is characterized by an optimal ratio of sensitivity and specificity in assessing the cumulative risk of developing such SAH complications as secondary ischemia combined with cerebral angiospasm.

Subarachnoid haemorrhage (SAH) is associated with a 30-day mortality rate of 50% and is one of the most life-threatening cerebrovascular diseases. Objective. Toevaluatetheprognosticsignificance and informativeness of some clinical indicators, highlighting the most optimal and reliable potential factors in the development of a mathematical equation for calculating the personal probability of complications in patients with subarachnoid hemorrhage of atraumatic etiology. Materials and methods. A clinical experimental study involved 87 patients with SAH, 44 were men, 43 – women. On the first day after SAH, half of the patients were hospitalized – 46 people (52,87%). Results. The constructed model for calculating the probability of events such as secondary ischemia, hydrocephalus, or cerebral vasospasm over the next 14 days indicates the correctness and adequacy of the constructed model of logistic regression.The personal probability of a complication is calculated by the formula: p = 1 / (1 + e-z), where p is the % probability of a complication of SAH; z = –45,5 + 17,5* Copeptine –0.44 × Na + 0,06 × Age + 1,99 × Ball (Hunt-Hess). Conclusions. The prognostic model allows us to consider that secondary ischemia and cerebral vasospasm are not only predictors of poor prognosis and potential factors for the formation of complications, but also are indicators for the correct determination of  individual cumulative risk in SAH. Keywords: notraumatic  hemorrhage, C. S. Ogilvy, copeptin, SIADH syndrome, hyponatremia, prognosis, logistic regression.

Зв'язок роботи з науковими програмами, планами, темами. Робота є фрагментом НДР кафедри нервових хвороб ДЗ «Запорізька медична академія післядипломної освіти МОЗ України»: «Комплексна діагностика та алгоритми прогнозування перебігу субарахноїдальних крововиливів у хворих різних вікових груп», № держ. реєстрації 0115U000657. Актуальність. Субарахноїдальний крововилив (САК)-один з найтяжких типів порушень мозкового

The purpose of the study was to investigate the clinical and statistical characteristics of the course of the disease, to assess the dynamics of the results according to the neurological scales, and to reveal the structure of complications in patients hospitalized for subarachnoid haemorrhage of non-traumatic aetiology. Materials and methods. 87 patients with subarachnoid haemorrhage were examined, 38 of them (43.68%) had isolated subarachnoid haemorrhage, 14 (16.09%) had subarachnoid parenchymal, 29 (33.33%) had subarachnoid ventricular, and 6 (6.9%) had subarachnoid-parenchymal ventricular haemorrhage. The total number of mixed haemorrhages made up 56.32%. In the routine clinical examination the C.S. Ogilvy et B.S. Carter Scale and the GOSE Scale were additionally included. Results. The majority of patients, 33 patients (37.93%), had subarachnoid haemorrhage of a mild severity according to the classification of the World Federation of Neurosurgeons that corresponded to 15 scores by the Glasgow Coma Scale and the absence of motor and speech deficit. The second degree of the severity was diagnosed in 37 people (42.53%) that corresponded to 13-14 scores according to the Glasgow Coma Scale and no motor and speech deficit. The next small group of patients, 14 patients (16.09%), had the 3 degree of the severity, i.e. 13 - 14 scores according to the Glasgow Coma Scale and a certain degree of motor and / or speech deficiency. Two individuals (2.30%) were assessed as having the 4 degree that was 7–12 scores by the Glasgow Coma Scale and the presence / absence of motor and / or speech deficit. One patient (1.15%) belonged to the 5 category, whose condition was assessed as extremely severe, 3-6 scores by the Glasgow Coma Scale and the presence / absence of motor and / or speech deficit. 76 patients with the subarachnoid haemorrhage assessed as having from 0 to 2 scores had 78-80% likelihood of successful outcomes according to the generalizing classification scale for the assessment of the subarachnoid haemorrhage result forecast (CSU. Ogilvy ET B.S. Carter). 10 patients (11.49%) with 3 scores demonstrated a less successful outcome. One patient (1.15%) was found to have 25% risk of adverse outcome and a total of 4 scores. Conclusion. The following risk factors for the development of subarachnoid haemorrhage were identified: the presence in of subarachnoid haemorrhage among relatives in the family history; history of bad habits including smoking, alcohol abuse; history of hypertension, atherosclerosis and hypercholesterolemia; concomitant diseases, including coronary heart disease, peptic ulcer and diabetes mellitus.