急性颅脑损伤后血管内皮细胞钙黏蛋白和精氨酸加压素的动态变化

Changes of VE-cadherin and arginine vasopressin in patients with acute brain injuries

目的 研究急性颅脑损伤后血中血管内皮细胞钙黏蛋白（VE—cadherin）和精氨酸加压素（arginine vasopressin，AVP）的动态变化及其与继发性脑水肿的关系。方法 采用酶联免疫吸附法（ELISA）检测VE—cadherin含量，采用放射免疫法检测AVP含量，回顾性分析110例急性颅脑损伤住院患者伤后12h、伤后3，5d血中VE—cadherin和AVP含量，并结合临床表现、影像学检查及格拉斯哥预后评分（GOS）进行比较分析。结果本组110例急性颅脑损伤患者伤后早期（12h内）血VE—cadherin和AVP含量随着格拉斯哥昏迷评分（GCS）下降均有不同程度的升高。颅脑损伤越严重，VE—cadherin和AVP升高越明显，脑水肿程度越重，脑水肿高峰持续时间越长（P〈0．01）。颅脑损伤早期血VE—cadherin和AVP含量与脑水肿严重程度（r=0．69，0．65，P〈0．01）和脑水肿高峰持续时间（r=0．70，0．64，P〈0．01）呈正相关。此外，不同COS组之间VE—cadherin和AVP差异亦有统计学意义，其中预后不良组血VE—cadherin和AVP水平在伤后5d持续升高，而且显著高于预后良好组和正常对照组（P〈0．05或P〈0．01）。同时急性颅脑损伤后血VE-cadherin和AVP的含量呈正相关（r=0．72，P〈0．01）。结论急性颅脑损伤后血VE-cadherin和AVP的变化与继发性脑水肿存在一定的相关性。

Objective To observe the changes of serum vascular endothelium-cadherin （VE-cadherin） and plasma arginine vasopressin （AVP） in patients with acute brain injury, and to investigate the VE-cadherin and plasma AVP related to brain edema and prognosis following acute brain injury. Method ELISA was used to measure the serum VE-cadherin level and radioimmunoassay was used to measure serial concentration of AVP in plasma of 110 patients with acute brain injury 12 hours and 3 and 5 days after brain injury. The outcome was estimated in combination of clinical manifestation, iconographic findings and Glasgow Outcome Scale （ GOS）. Results The levels of VE-cadherin and AVP increased significantly over 12 hours after brain injury with reduction of GCS. The severer brain injury resulted in higher levels of VE-cadherin and AVP, and prolongation of peak brain edema （ P 〈 0.01 ）. VE-cadherin levels showed positive correlation with severity of brain edema （ r = 0. 69, P 〈 0.01 ） and prolongation of brain edema （ r = 0.70, P 〈 0.01 ）. AVP levels had positive correlation with severity of brain edema （ r = 0.65, P 〈 0.01 ） and prolongation of brain edema （ r = 0.64, P 〈 0.01 ）. Furthermore, there were sig- nificant increases in VE-cadherin and AVP levels in patients with low GOS groups （ P 〈 0. 01 ）. The VE-cadherin and AVP levels in poor outcome group persistently increased for 5 days after brain injury and were higher than those in good outcome group and normal control group. There were a correlation between VE-cadherin and AVP in patients with acute brain injury （ r = 0.75, P 〈 0.01 ）. Conclusions VE-cadherin and AVP levels are closely associated with the prognosis of patients after acute brain injury. VE-cadherin and AVP may play pivotal roles in the pathogenesis of brain edema after acute brain injury.