动脉瘤性蛛网膜下腔出血后脑血管痉挛与血浆花生四烯酸代谢产物的关系

Relationship between arachidonic acid metabolites in plasma and cerebral vasospasm after aneurysmal subarachnoid hemorrhage

目的探讨动脉瘤性蛛网膜下腔出血(aSAH)病人血浆花生四烯酸代谢产物的含量与脑血管痉挛(CVS)发生、发展之间的关系。方法选取34例aSAH病人作为研究组,在aSAH后第1、3、7、14天抽取外周静脉血测定血栓素B2(TXB2)和6-酮-前列腺素F1α(6-Keto-PGF1α)的含量。另选取同时期健康成人6例作为对照组,进行对比研究。结果研究组发生CVS 23例,其中表现为迟发性缺血性神经功能障碍(DIND)的症状性CVS 10例,无症状性CVS(无DIND)13例。与对照组相比,研究组各时间点血TXB2含量均明显升高,而血6-Keto-PGF1α含量变化无显著性差异;与无CVS病人相比,CVS病人血TXB2含量在各时间点均明显升高,而血6-Keto-PGF1α含量仅在第7天时明显降低;与无DIND病人相比,DIND病人血6-Keto-PGF1α含量在第1、3、14天明显降低,而血TXB2含量仅在第3天时明显升高。结论 aSAH后CVS、DIND的发生、发展与血TXB2、6-Keto-PGF1α含量变化可能存在相关性。

Objective To investigate the relationship between the level of arachidonic acid metabolites in plasmaand the development and progression of cerebral vasospasm （CVS） after aneurysmal subarachnoid hemorrhage （aSAH）. Methods Thirty-four patients withaSAH were selected as study group. The peripheral blood was collected on the 1, 3, 7, 14 day after aSAH, and the levels of 6-keto-prostaglandin F1α（6-Keto-PGF1α） and thromboxane B2 （TXB2） in plasma were measured. Meanwhile, six healthy volunteers wereselected as control group. The comparative study was performed. Results CVS occurred in 23 patients in study group, including symptomatic CVS showing delayed ischemic neurological deficits （DIND） in 10 patients and non-symptomatic CVS （non-DIND） in 13.Compared with the control group, the TXB2 level in plasma significantly increased in every time point in study group, while the 6-keto-PGFla, level showed no significant difference between the two groups. Compared with the non-CVS patients, the plasma TXB2level significantly increased in every time point in CVS patients, while the 6-keto-PGFla level decreased significantly just on the 7 day. Compared with the non-DIND patients, the 6-keto-PGFla. level decreased significantly on the 1, 3, 14 days in DIND patients, while theplasma TXB2 level significantly increased just on the 3 day. Conclusion There is a possible correlation between both the TXB2 and 6-keto-PGFla levels and both development and progression of CVS after aSAH.