血浆不对称二甲基精氨酸表达水平与脑血管痉挛的相关性研究  

Correlation between plasma asymmetric dimethylarginine and cerebral vasospasm after subarachnoid hemorrhage

作　　者：丛建军[1] 张天喜[1] 高宝山[1] 常庆勇[1] 钱盛伟[1] 张继志[1] 金点石[1] 黄坤[1] 曲凯[1] 周敬斌[1] 

机构地区：[1]大连大学附属中山医院神经外科,116001

出　　处：《中国医药》2009年第6期431-433,共3页China Medicine

摘　　要：目的研究蛛网膜下腔出血后不同时期血浆不对称二甲基精氨酸（ADMA）的表达水平，探讨蛛网膜下腔出血后不平衡二甲基精氨酸与脑血管痉挛发病机制的相关性。方法选取38例蛛网膜下腔出血患者，再选择20例健康体检者为对照组。采用双抗体夹心酶标免疫分析法测定出血后不同时段（出血后1～3d、4～7d、14—21d）血浆ADMA水平。同期采用经颅多普勒测量颅内动脉的血流速度，连续或间断监测脑血管的痉挛状况。根据有无脑血管痉挛将38例患者分为血管痉挛组与非血管痉挛组。对测定结果进行分析。结果与对照组比较，蛛网膜下腔出血后血管痉挛组血浆ADMA浓度明显升高，2组间差异有统计学意义（P〈0．01）；无血管痉挛组水平轻度升高，与对照组比较，差异无统计学意义（P〉0．05）。脑血管痉挛在蛛网膜下腔出血后1～3d出现2例，4～7d28例，14—21d以后1例。4～7d时出现脑血管痉挛的患者ADMA含量较时间段的患者明显升高，与其他2个时间段相比，差异有统计学意义（P〈0．01）。2例脑动脉瘤再破裂，1例重度脑挫伤脑疝死亡。6例治疗过程中新发脑梗死病情加重，经治疗后好转。其他患者疗效满意。结论ADMA参与了蛛网膜下腔出血病理生理过程，与脑血管痉挛的关系密切。Objective To detect plasma concentrations of asymmetrical dimethylarginine （ADMA） at different time points after subarachnoid hemorrhage （SAH） and to further observe the possible function of ADMA in the pathogenesis of cerebral vasospasm after SAH. Methods Plasma ADMA concentrations was measured in patients who were diagnosed SAH （n = 38） at the different period （1-3 days,4-7 days and 14-21 days after hemorrhage） by Sandwich enzyme immunoassay technique and the blood flow rate was observed in intracranial artery by TCD, to observe the cerebral vasospasm continuously or intermittently. These patients were separated into two groups according to the occurrence of cerebral vasospasm. Healthy persons （n = 20） after physical examine were allocated to be a control group. Results The mean density in vasospasm-group was obviously higher than that in control group （ P 〈 0.01 ）. The mean density in non-vasospasm-group was slightly higher than the one in control group （P 〉0.05）. Cerebral vasospasm occurred in 2 cases during 1-3 days, in 28 cases during 4-7days and in 1 case after 14-21 days. The ADMA in 4-7 day group was obviously higher than that in other groups. There was statistieal significance among the 3 groups. （P 〈0.01 ） . 2 patients died of disruption of aneurysm,1 patient died of cerebral hernia, 6 patients had good outcome after therapies despite of newly cerebral infarct and others fully recovered. Conclusion AMDA participates in the pathological process of SAH and is correlated with delayed cerebral vasospasm.

关 键 词：蛛网膜下腔出血 不对称二甲基精氨酸 脑血管痉挛 

分 类 号：R743.34[医药卫生—神经病学与精神病学]