vWFGMP-140在动脉瘤性蛛网膜下腔出血患者中的动态变化及意义

Dynamic changes and clinical value of von Willebrand factor and GMP - 140 in patients with aneurysmal subarachnoid hemorrhage

的了解血管性假血友病因子（vwF）与GMP-140在动脉瘤性蛛网膜下腔出血（ASAH）患者中的动态变化及意义。方法采用回顾性分析方法，将苏州大学附属第一医院神经外科2010-04-2011-04收治的动脉瘤性蛛网膜下腔出血患者29例，分成迟发性脑缺血组（DCI组）和非迟发性脑缺血组（无DCI组）、脑血管痉挛组（CVS组）和无痉挛组（无CVS组）、预后良好组和预后不良组，并引入正常健康体检者20例作为对照组。分别在SAH后第1天、第4天、第10天收集静脉血，使用ELISA方法检测vWF和GMP-140水平，观察其动态变化；TCD检测大脑中动脉的血流速度（VMCA），出院时行GOS预后评分。结果①血浆vWF水平在DCI组、CVS组及预后不良组第1天、第4天、第10天均高于正常对照组，DCI组与无DCI组在第1天、第4天比较差异有统计学意义（P〈0．05）；第4天、第10天CVS组与无CVS组、预后良好组与预后不良组比较差异有统计学意义（P〈0．01）。②血浆GMP一140水平在各组早期均显著升高，在第1天预后良好组与预后不良组比较差异有统计学意义。结论早期血浆vwF、GMP-140水平与预后相关，并且早期vWF水平与DCI发生相关。

Objective To study the clinical values of dynamic changes of von Willebrand factor and GMP - 140 in aneurysmal subarachnoid hemorrhage. Methods This retrospective analysis included twenty nine patients with aneurysmal subarachnoid hemorrhage admitted to the Department of Neurosurgery, the First Affiliated Hospital of Soochow University, from April 2010 to April 2011. They were divided into delayed cerebral ischemia group （ DCI group） and non - delayed cerebral ischemia group （no DCI group）, or cerebral vasospasm group （CVS group） and no spasm group （no CVS group）, or good prognosis group and poor prognosis group, and 20 cases of healthy people as control group. Venous blood was drawn in tubes at 3 time points： 1 day after SAH, 4 day after SAH, and 10 day after SAH to determine plasma concentrations of vWF and GMP - 140 via enzyme - linked immunosorbent assay （ELISA）. TCD was used to measure VMCA. GOS score was measured before discharge. Results The concentration of vWF at days of 1,4, 10 after SAH were significantly higher in DCI group, CVS group and poor prognosis group compared with those of the control group. The concentrations of vWF were different in DCI group and no DCI group at day 1 and day 4 （ P 〈 0.05 ）. There were significant difference of vWF concentration between CVS group and no CVS group or good prognosis group and poor prognosis group at day 4 and day 10 （ P 〈 0.01 ）. The concentration of GMP - 140 was relatively high at day 1 in all the groups, but there were significant difference between good prognosis group and poor prognosis group at day 1. Conclusion Early plasma increased vWF and GMP - 140 is associated with prognosis, and early plasma vWF can predict the DCI.