胰岛素加维生素C对兔实验性蛛网膜下腔出血后脑血管痉挛的作用  

Effect of combined use of insulin and antiscorbic acid on cerebral vasospasm after subarachnoid hemorrhage

作　　者：李首春[1] 史继新[2] 周梦良[2] 吴波[3] 印红霞[2] 闫伟[2] 成惠林[2] 

机构地区：[1]南方医科大学,广东广州510515 [2]中国人民解放军南京军区总医院神经外科,江苏南京210002 [3]中国人民解放军南京军区总医院病理科,江苏南京210002

出　　处：《中国微侵袭神经外科杂志》2007年第6期266-268,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的初步探讨胰岛素加维生素C对蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)的作用。方法雄性新西兰白兔35只,随机分为4组:对照组(5只)、SAH组(10只)、SAH+胰岛素组(10只)、SAH+维生素C+胰岛素组(10只)。采用兔枕大池2次注血法建立SAH模型。治疗组动物分别在第1次注血后30min开始给药并持续至实验结束。在实验第5天采用灌注固定法处死白兔,取基底动脉和相邻部分脑组织,行苏木精-伊红染色后测量基底动脉的横截面积以评估CVS的程度,免疫组化染色测定血管内皮细胞胰岛素受体(insulin receptor,InR)的表达。结果维生素C和胰岛素联合应用组的基底动脉横截面积为(410688.90±19618.13)μm2,对照组为(462107.90±42999.4)μm2,两组比较,差异无统计学意义;SAH组和单独应用胰岛素治疗组血管横截面积分别为(236486.37±8721.3)μm2和(245787.8±23878.1)μm2,与对照组比较,差异均有统计学意义。血管内皮细胞胰岛素受体在SAH组和单独应用胰岛素治疗组表达明显下调,而胰岛素和维生素C联合应用显著增加胰岛素受体的表达。结论维生素C和胰岛素联合运用可有效缓解兔实验性SAH后的脑血管痉挛,而单独应用胰岛素未能缓解血管痉挛。Objective To explore the effect of insulin plus Vitamin C on delayed cerebral vasospasm （CVS） after subarachnoid hemorrhage （SAH）. Methods Thirty-five male New Zealand white rabbits were randomized to four groups： control group （n=5）, SAH group （n=10）, insulin treatment group （n=10） and combined treatment with vitamin C and insulin group （n=10）. SAH was induced by injecting blood into the cistern magna of rabbit 2 times. The treatment with insulin was started in the 3rd group and that with Vitamin C ＋ insulin in the 4th group at 30 minutes after the first injecting blood, and lasting up to the end of this experiment. The rabbits were sacrificed by perfusion-fixation and the basilar artery and part of adjacent brain tissue were taken on the 5th day. The degree of CVS was evaluated by measuring the cross-sectional area of the basilar arterial lumen after hematoxylin and eosin staining, and the expression of insulin receptors in the vascular wall was examined by immunohistochemical staining. Results The mean value of cross-sectional area of the arterial lumen in the combined treatment group was 410688.90±19618.13μm^2, while that of the control group was 462107.90±42999.40μm^2. There was no significant difference between the two groups. The mean value of cross-sectional area of the arterial lumen in the SAH group was 236486.37±8721.3μm^2 and that of the insulin group was 245787.8±23878.1μm^2. There was a significant difference between the control group and the SAH group or insulin group. Expression of insulin receptor was down-regnlated significantly in the SAH group and insulin group on the vascular endothelial cell, and up-regnlated markedly in the combined treatment group. Conclusion Combined use of vitamin C and insulin, not insulin alone, can effectively improve spasm of the cerebral vasculature after SAH.

关 键 词：蛛网膜下腔出血 血管痉挛 颅内 胰岛素 抗坏血酸 

分 类 号：R743.3[医药卫生—神经病学与精神病学]