胸腹主动脉瘤手术患者血脑屏障损伤生化标志物的监测与评估  

Blood-brain barrier injury of 15 cases of patients during operative period of thoracoabdominal aortic aneurysm surgery

作　　者：邹以席[1] 黄方炯[1] 孙东[1] 吴强[1] 于建波[1] 韩博[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科,北京100029

出　　处：《心肺血管病杂志》2011年第4期311-315,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨胸腹主动脉瘤手术患者的血脑屏障损伤,评价血清和脑脊液S100B蛋白、神经元特异性烯醇化酶(NSE)和胶质原纤维酸性蛋白(GFAP)诊断血脑屏障损伤的价值。方法:检测和分析15例胸腹主动脉置换患者,男性11例,女性4例,平均年龄46岁。围手术期各时间点白蛋白商值和脑脊液-IgG指数,并以其为标准评估血脑屏障损伤、以及其与血清和脑脊液的S100B、GFAP和NSE蛋白的相关性。结果:12例在主动脉重新开放后2 h至12 h时间内,白蛋白商值升高至9～28,而脑脊液-IgG指数升高至0.8～2,有3例患者血脑屏障损伤重:2例白蛋白分别升高至38.6和41.8,1例脑脊液-IgG指数升高至3.06。结论:胸腹主动脉手术中白蛋白商值和脑脊液-IgG指数会出现一过性轻到中度升高,提示血脑屏障一过性轻中度损害可能,未发现白蛋白商值和脑脊液-IgG指数与S100B、GFAP及NSE具有相关性。Objective：To study the degree of blood-brain barrier injury of patients during operative period of thoracoabdominal aortic aneurysm surgery,and search the desirable biochemical markers of blood-brain barrier ischemic injury.Methods： Measuring and analyzing the album quotient（AQ） and cerebrospinal fluid IgG index of 15 cases of patients（11 male,4 female;average age 46） at nine fixed time points during operative period of thoracoabdominal aortic aneurysm surgery by which the degree of blood-brain barrier injury was evaluated.And the correlations between them and S100B,glial fibrillary acidic protein（GFAP） and glial fibrillary acidic protein（NSE） concentration in serum and cerebrospinal fluid of patients were analyzed.Results： The value of album quotient of 12 patients elevated to 9 to 28 between 2 to 12 hours after reopening of cross-clamped aorta.And that of cerebrospinal fluid IgG index elevated to 0.8 to 2.Only did three cases of heavy blood-brain barrier injury occurred.The album quotient value of two patient separately increased to 38.6 and 41.8,and the cerebrospinal fluid IgG index value of another patient increased from 0.79 to 3.06.Conclusion： Mild to moderate function damage of blood-brain barrier occurred during thoracoabdominal aortic aneurysm surgery by measuring album quotient and cerebrospinal fluid IgG index.There were no satisfactory correlation between album quotient and cerebrospinal fluid-IgG index and S100B,GFAP and NSE concentration in serum and cerebrospinal fluid of patients.

关 键 词：血脑屏障 胸腹主动脉瘤 白蛋白商值 脑脊液IgG指数 

分 类 号：R543.1[医药卫生—心血管疾病]