动脉瘤性蛛网膜下腔出血患者脑脊液白细胞介素-6水平研究

Study of cerebrospinal fluid interleukin-6 levels in patients with aneurysmatic subarachnoid hemorrhage

目的探讨动脉瘤性蛛网膜下腔出血(SAH)患者脑脊液白细胞介素6(IL-6)水平变化及临床意义。方法 45例动脉瘤性SAH患者,均行开颅动脉瘤夹闭治疗,其中23例术后腰大池置管或脑室置管外引流术并注入尿激酶治疗,22例术后间断腰穿治疗,所有的45例患者均常规尼莫地平治疗。此45例患者和对照组10例患者均收集治疗后1～3 d、5～7 d、9～11 d、13～15 d的脑脊液标本,对脑脊液IL-6水平进行动态测定,并观察其疗效和脑血管痉挛的情况。结果动脉瘤性蛛网膜下腔出血患者脑脊液IL-6显著高于正常脑脊液水平,5～7 d达高峰值,发病后不同时期各均值变化明显(P<0.05),IL-6的升高与病情轻重和出血量及脑血管痉挛有明显的关系,早期的脑脊液引流治疗可使IL-6水平下降趋势明显。结论 IL-6可作为观察病情及脑血管痉挛的指标,早期检测脑脊液中IL-6水平可为指导治疗及预测预后提供依据,试验证实早期血性脑脊液外引流是预防脑血管痉挛的有效措施。

Objective To approach variance and clinical significance of cerebrospinal fluid（CSF）interleukin-6（IL-6）levels in patients with aneurysmatic subarachnoid hemorrhage（SAH）.Methods 45 patients with aneurysmatic SAH were underwent craniotomy for aneurysm clipped treatment,including 23 cases of postoperative lumbar cistern tube or cerebral ventricle catheter drainage and injection of urokinase in treatment,while the other 22 cases with intermittent lumbar puncture.All the 45 patients were adopted the routine treatment with nimodipine.CSF samples were collected and determined after treatment with 1-3 d,5-7 d,9-11 d,13-15 d.At the same time,the curative effects were also observed.Results The CSF IL-6 levels in patients with aneurysmatic SAH were significantly higher than those of normal,with 5-7 d reaching high-peak,and the mean changes in different periods were significantly（P〈0.05）.The levels of CSF IL-6 had positive correlation with the severity of illness,the volume of hemorrhage and occurrence of cerebral vasospasm,while it declined significantly from early drainage of CSF.Conclusions The CSF IL-6 levels can be used as observation and cerebral vascular spasm index,and the early detection of CSF IL-6 levels as the guide to treatment and prognosis prediction.The trial confirmed early hemorrhagic cerebrospinal fluid drainage is an effective measure for prevention of cerebral vasospasm.