动脉瘤性蛛网膜下腔出血患者vWF、GMP-140及ADAMTS13的表达水平及临床意义

Expression Levels and Clinical Significance of vWF, GMP-140 and ADAMTS13 in Patients with Aneurysmal Subarachnoid Hemorrhage

目的:探讨动脉瘤性蛛网膜下腔出血(aSAH)患者中血管性假血友病因子(v WF)、血小板膜糖蛋白-140(GMP-140)、血管性血友病因子裂解蛋白酶(ADAMTS13)的表达水平及临床意义。方法:选取2014年1月至2016年12月我院神经外科收治的83例aSAH患者,分为脑血管痉挛(CVS)组37例和无CVS组46例;迟发性脑缺血(DCI)组31例和非DCI组52例;根据不同动脉瘤直径分为<5 mm组43例,5-10 mm组29例,>10 mm组11例;预后良好组49例和预后不良组34例,检测aSAH患者血浆v WF、GMP-140、ADAMTS13水平,并分析各指标之间的相关性。结果:CVS组患者第4 d、10 d血浆v WF水平高于非CVS组,第1 d、4 d、10 d血浆GMP-140水平高于非CVS组,第1 d、10 d血浆ADAMTS13水平低于非CVS组,差异均有统计学意义(P<0.05)。DCI组患者第1 d血浆v WF水平高于非DCI组,ADAMTS13水平低于非DCI组,第4 d血浆v WF、GMP-140水平高于非DCI组,差异均有统计学意义(P<0.05)。>10 mm组患者第1 d、4 d血浆v WF、GMP-140水平高于<5 mm组和5-10 mm组,且5-10 mm组第4d的血浆v WF水平、第1 d的血浆,水平均高于<5 mm组,差异有统计学意义(P<0.05);>10 mm组患者第1d的血浆ADAMTS13水平低于<5 mm组和5-10 mm组,且5-10 mm组低于<5 mm组,差异有统计学意义(P<0.05)。预后良好组患者第4 d、10 d血浆v WF水平低于预后不良组,第1 d、4 d、10 d血浆GMP-140水平低于预后不良组,第1 d、4 d血浆ADAMTS13水平高于预后不良组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,第1 d、4 d血浆v WF与GMP-140呈正相关,与ADAMTS13呈负相关,GMP-140与ADAMTS13呈负相关(r=0.334、-0.426、-0.398、0.278、-0.311、-0.235,P<0.05),第10 d血浆v WF、GMP-140、ADAMTS13之间无明显相关性(P>0.05)。结论:v WF、GMP-140、ADAMTS13与CVS、DCI、动脉瘤直径以及预后密切相关,联合检测有助于综合评估aSAH患者病情,改善预后,值得临床推广。

Objective： To investigate the expression levels and clinical significance of von Willebrand factor（v WF）, granule membrane protein-140（GMP-140）, von Willebrand factor cleaving protease（ADAMTS13） in patients with aneurysmal subarachnoid hemorrhage（aSAH）. Methods： 83 patients with aSAH treated in neurosurgery of our hospital from January 2014 to December 2016 were selected.They were divided into 37 cases of cerebral vasospasm（CVS） group and 46 cases of non CVS group, and 31 cases of delayed cerebral ischemia（DCI） group and 52 cases of non DCI group. They were divided into 43 cases of 5 mm group, 29 cases of 5-10 mm group, 11 cases of 10 mm group according to the diameter of different aneurysms, and divided into 49 cases of good prognosis group and 34 cases of poor prognosis group. The levels of plasma v WF, GMP-140 and ADAMTS13 in patients with aSAH were detected,and the correlation between the indexes were analyzed. Results： The plasma levels of v WF in CVS group were higher than that in non CVS group on the fourth day, tenth day, the plasma levels of GMP-140 in CVS group were higher than that in non CVS group on the first day, fourth day,tenth day, the plasma levels of ADAMTS13 in CVS group were lower than that in non CVS group on the first day, tenth day, the differences were statistically significant（P〈0.05）. The plasma levels of v WF in DCI group were higher than that in non DCI group on the first day, the levels of ADAMTS13 were lower than that in non DCI group, the plasma levels of v WF and GMP-140 were higher than that in non DCI group on the fourth day, the differences were statistically significant（P〈0.05）. The plasma levels of v WF and GMP-140 in 10 mm group were higher than that in 〈5 mm group and 5-10 mm group on the first day, fourth day, the plasma levels of v WF on the fourth day and GMP-140 levels on the first day were higher than that in 〈5 mm group, the differences were statistically significant（P〈0.05）. The plasma levels of ADAMTS13 in 10 mm group were lower than that in 5 mm group and 5-10 mm group on the first day, 〈5 mm group were lower than 5-10 mm group, the differences were statistically significant（P〈0.05）. The plasma levels of v WF in good prognosis group were lower than that in poor prognosis group on the fourth day, tenth day, the plasma levels of GMP-140 in good prognosis group were lower than that in poor prognosis group on the first day, fourth day, tenth day, the plasma levels of ADAMTS13 in good prognosis group were higher than that in poor prognosis group on the first day, fourth day, the differences were statistically significant（P〈0.05）.Pearson correlation analysis showed that plasma v WF was positively correlated with GMP-140 and negatively correlated with ADAMTS13, GMP-140 was negatively correlated with ADAMTS13 on the first day, fourth day（r=0.334,-0.426,-0.398, 0.278,-0.311,-0.235, P〈0.05）. There was no correlation between the plasma levels of v WF, GMP-140, ADAMTS13 on the tenth day（P〉0.05）. Conclusion： The plasma levels of VWF, GMP-140, ADAMTS13 and CVS, DCI, aneurysm diameter and prognosis are closely related, joint detection helps to comprehensively assess the condition of patients with aSAH, improve prognosis, it is worthy of clinical promotion.