脑脊液中TGF-β1、PICP、PⅢNP、HA、LN在蛛网膜下腔出血后脑积水发生中的意义

Roles of transforming growth factor-beta 1,procollagen I C-terminal propeptide,N-terminal procollagen Ⅲ propeptide,hyaluronic acid,and laminin in cerebrospinal fluid in the development of hydrocephalus after hemorrhage

目的探讨蛛网膜下腔出血后转化生长因子β1(Transforming growth factor-β1,TGF-β1)、Ⅰ型前胶原前肽(procollagenⅠCpropeptide,PICP)、Ⅲ型前胶原前肽(procollagenⅢN-propeptide,PⅢNP)、透明质酸(hyaluronic acid,HA)及层黏蛋白(laminin,LN)在脑积水形成的过程中的作用。方法收集我院颅脑损伤及自发性颅内出血(波及到蛛网膜下腔及脑室系统)的患者,入院时不同时间点检查患者脑脊液中TGF-β1、PICP、PⅢNP、HA、LN的水平,同时随访上述患者在半年内发生脑积水的情况,比较出现与未出现脑积水患者脑脊液中TGF-β1、PICP、PⅢNP、HA、LN水平的差异。分析患者脑脊液中TGF-β1分别与PICP、PⅢNP、HA、LN表达的相关性及其时间-浓度关系。结果收集病例83例,随访半年,53例未出现脑积水(A组),30例出现脑积水(B组),结果显示,出现脑积水的患者在脑脊液各个时间点的TGF-β1、PICP、HA、LN水平均显著高于未出现脑积水的患者。83例患者脑脊液中TGF-β1与PICP、PⅢNP、HA、LN的表达呈正相关,相关系数分别为0.8248、0.7951、0.9078、0.7572。脑脊液中TGF-β1在7天时达到高峰期,之后逐渐下降,而PICP、PⅢNP、HA、LN在脑脊液中的表达是在TGF-β1达到高峰后快速上升,后缓慢下降。结论脑脊液中TGF-β1、PICP、PⅢNP、HA、LN与脑脊液系统出血后慢性脑积水的发生过程中发挥着重要作用。TGF-β1在脑脊液系统出血后的表达可能促进了PICP、PⅢNP、HA、LN的表达。

Objective To investigate the roles of transforming growth factor-beta 1（ TGF-β1）,procollagen I C-terminal propeptide（PICP）,N-terminal procollagen Ⅲ propeptide（PⅢNP）,hyaluronic acid（HA）,and laminin（LN） in the development of hydrocephalus after hemorrhage in the cerebrospinal fluid system. Methods The patients with traumatic brain injury and spontaneous intracranial hemorrhage（ involving the subarachnoid space and the ventricular system） who were treated in our hospital were enrolled,and the levels of TGF-β1,PICP,PⅢNP,HA,and LN in cerebrospinal fluid were measured at different time points after admission.The patients were followed up to observe the development of hydrocephalus within half a year,and the levels of TGF-β1,PICP,PⅢNP,HA,and LN in cerebrospinal fluid were compared between the patients with hydrocephalus and those without hydrocephalus. The correlation of TGF-β1 with PICP,PⅢNP,HA,and LN expression and their time-concentration relationship were analyzed. Results A total of 83 patients were enrolled,and after the follow-up for half a year,53 patients did not have hydrocephalus（ group A） and 30 had hydrocephalus（ group B）. Group B had significantly higher levels of TGF-β1,PICP,HA,and LN in cerebrospinal fluid than group A at all time points. In all patients,TGF-β1 was positively correlated with PICP,PⅢNP,HA and LN（ r = 0. 8248,0. 7951,0. 9078,and 0. 7572）. TGF-β1 in cerebrospinal fluid reached the highest level on day 7 and then gradually decreased,while the expression of PICP,PⅢNP,HA,and LN started to increase rapidly when TGF-β1 reached the highest level and then slowly decreased. Conclusions TGF-β1,PICP,PⅢNP,HA,and LN in cerebrospinal fluid play important roles in the development of chronic hydrocephalus after hemorrhage in the cerebrospinal fluid system,and TGF-β1 may promote the expression of PICP,PⅢNP,HA,and LN.