动脉瘤性蛛网膜下腔出血患者血液及脑脊液中内皮素和一氧化氮含量变化

The changes of endothelin and nitric oxide contents in the blood and CSF of subarachnoid hemorrhage patients with aneurysm

目的探讨动脉瘤性蛛网膜下腔出血（ＳＡＨ）患者血液及脑脊液中内皮素（ＥＴ）和一氧化氮（ＮＯ）的含量与脑血管痉挛（ＣＶＳ）及临床病情的关系。方法采用放射免疫方法测定血液和脑脊液中ＥＴ含量；采用硝酸还原酶法测定血液和脑脊液中ＮＯ的代谢产物ＮＯ－ｘ（ＮＯ－２和ＮＯ－３）含量。结果ＳＡＨ后血液和脑脊液中ＥＴ含量增高（Ｐ＜００５），且重症组高于轻症组（Ｐ＜００５）；而ＳＡＨ后血液和脑脊液中ＮＯ含量则下降（Ｐ＜００５），重症组下降更加明显（Ｐ＜００５）。结论提示ＳＡＨ后脑血管痉挛和迟发性脑缺血可能系ＥＴ升高和ＮＯ下降使大脑动脉持续收缩所致，且临床症状的严重程度与ＥＴ增高和ＮＯ下降的程度密切相关。本实验结果支持ＳＡＨ后ＣＶＳ发生机制中ＥＴ与ＮＯ动态平衡破坏学说。

Objective\ To evaluate the relations between endothelin (ET) and nitric oxide (NO) contents of blood and cerebrospinal fluid (CSF) and development of cerebral vasospasm (CVS) and clinical symptom of subarachnoid hemorrhage (SAH) patients with aneurysm. Methods\ The content of ET was assayed by radioimmunological technique,and metabolite of NO,NO - X(NO - 2 and NO - 3) was by HNO 3 reductase method.Results\ The ET contents of both blood and CSF in SAH patients were signifcantly higher than those in control group ( P <0.05),and the ET contents in serious group were higher than those in mild group ( P <0.05).The NO - X contents of both blood and CSF in the same patients were significantly lower than those in control group ( P <0.05),and the NO - X contents in serious group were lower than those in mild group ( P <0.05).Conclusion\ The appearance of CVS following SAH and the delayed cerebral ischemia were due to continuous constriction of cerebral artery,which was mediated by the increase of ET content and the reduce of NO content,and the severity of clinical symptom was in positive correlation to the raised degree of ET content and the reduced degree of NO content.It suggested that the disturbance of ET and NO plays an important role in the mechanism of CVS development after SAH attack.