吕艺伟,卢忠胜

非创伤性蛛网膜下腔出血（nSAH）引起的继发性脑损伤与患者长期预后密切相关，而原发出血所触发的剧烈全身性炎症反应及代谢紊乱是此过程的核心病理生理环节。传统的预后评估主要依赖于神经影像与临床分级。近年来，利用MIMIC-IV等大型重症监护数据库开展的研究，系统揭示了如白细胞与血小板衍生指标、血糖、电解质、血尿素氮、阴离子间隙等常规易得的全身性指标，与nSAH患者死亡率及不良功能结局之间存在独立关联。本文综述了基于此类真实世界数据的最新证据，阐述nSAH后全身性炎症反应综合征（SIRS）与代谢失衡的机制，总结关键生物标志物的预后预测价值，并讨论其整合入现有预测模型所面临的潜力与挑战。最后，对融合多组学与动态监测的未来研究方向进行展望，以期为nSAH的精准风险分层与个体化管理提供参考。

非创伤性蛛网膜下腔出血；预后；全身性炎症反应；代谢紊乱；生物标志物；MIMIC-IV；预测模型

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