动脉瘤性蛛网膜下腔出血患者血清血管假性血友病因子、内皮素-1含量变化及与脑血管痉挛的关系

The change of serum von Willebrand factor,endtohelin-1 concentrations in patients with aneurysmal subarachnoid hemorhage,and the ralation to cerebral vasospasm after aneurysmal subarachnoid hemorrhage

目的检测动脉瘤性蛛网膜下腔出血患者血清中血管假性血友病因子浓度、内皮素-1含量的动态变化,分析二者与脑血管痉挛发生发展的关系,为a NSAH后CVS的发病机制及防治措施提供实验数据和理论依据。方法实验组分别于入院时、术后3 d、术后1 w、术后2 w早晨抽取空腹血,并于当天进行TCD检查;对照组病例均静息30 min后抽取空腹血。分别采用ELISA法检测v WF浓度、放射免疫分析检测ET-1含量。结果 (1)术后1 w组与其他实验组v WF浓度、ET-1含量比较,差异均有统计学意义(P<0.05);而术后2 w血清v WF浓度、ET-1含量与术前相比较,差异均无统计学意义(P>0.05)。(2)术前CVS组和非CVS组血清v WF浓度与ET-1含量相比较差异均有统计学意义(P<0.01);术后CVS组与非CVS组血清v WF浓度与ET-1含量比较,差异也有统计学意义(P<0.01);术后CVS组v WF浓度、ET-1含量与术前CVS组相比有统计学意义(P<0.01)。(3)实验组中血清v WF、ET-1含量与脑血管痉挛程度正相关(v WF:r=0.78613,P<0.01;ET-1:r=0.61904,P<0.01)。(4)血清v WF浓度与ET-1含量呈正相关(r=0.496,P<0.01)。结论血清v WF和ET-1可作为a NSAH后CVS的预防、疗效观察、判断预后的重要参考指标。

Objective To search for cerebral vasospasm＇s pathogenesy after aneurysmal subarachnoid hemorrhage,and the relation of v WF and ET-1 with cerebral vasospasm,to provide the experimental data for us to treat and prevent the occurrence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Methods Experiment group patients were taken suction blood and taken TCD on admission,3 d postoperation,1 w postoperation,2 w postoperation. The control group were taken suction blood after resting 30 minutes. We took ELISA to detect v WF concentrations and took radio-immunity to detect ET-1 concentrations. Results（ 1） Serum vwf and ET-1 concentration at 1 w postoperation compared with other group,the difference is was significant（ P 〈0. 05）. Serum vwf and ET-1 concentration at 2 w postoperation compared with admission,the difference is was unsignificant（ P 〈0. 05）.（ 2） Preoperative CVS v WF concentration is was higher than un CVS; preoperative CVS ET-1 concentration is was higher than un CVS. Postoperative CVS v WF concentration is was higher than un CVS（ P 〈0. 01）; postoperative CVS ET-1 concentration is was higher than un CVS（ P 〈0. 01）. Postoperative CVS vwf,ET-1 concentration is was higher than preoperative CVS（ P 〈0. 01）.（ 3） Serum vwf,ET-1 concentration is was direct correlation with CVS level by spearman correlation analysis（ vwf： r = 0. 78613,P 〈0. 01; ET-1： r = 0. 61904,P 〈0. 01）.（ 4） Serum v WF concentration is was direct correlation with serum ET-1 concentration（ r = 0. 496,P 〈0. 01）. Conclusion v Wf and ET-1 concentration could be usede as the significance refrence index to prevent the CVS,observe curative effect,judge outcome.