动脉瘤性蛛网膜下腔出血脑脊液可溶性Fas、Fas配体水平的变化与脑积水发生及预后的关系  

Changes and relationships between the levels of cerebrospinal fluid sFas / sFasL and hydrocephalus and prognosis in aneurysmal subarachnoid hemorrhage

作　　者：李嵌嵌 刘成辉[1] 王鹏[2] 詹升全[2] 郭文龙[2] 李炎稳[2] 周东[2] 

机构地区：[1]南方医科大学附属南海医院神经外科,佛山528200 [2]广东省人民医院神经外科

出　　处：《临床神经外科杂志》2015年第4期283-286,290,共5页Journal of Clinical Neurosurgery

基　　金：广东省科技计划项目(2011B061300055)

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血（a SAH）患者脑脊液可溶性Fas（s Fas）、Fas配体（s Fas L）水平的变化及其与慢性脑积水和预后的关系。方法给118例a SAH患者在发病后不同时间点行腰穿检查,用酶联免疫吸附试验（ELISA）检测脑脊液s Fas、s Fas L浓度。另选取12例发热颅内感染待排患者为对照组。在发病后3个月时,用格拉斯哥预后量表（GOS）评定a SAH患者的预后。对a SAH组发生脑积水与无脑积水患者,以及不同预后患者之间的脑脊液s Fas、s Fas L浓度进行比较。结果 a SAH组患者中发生慢性脑积水24例（20%）。a SAH组患者发病后各时间点脑脊液s Fas、Fas L浓度均明显高于对照组（均P〈0.05）。脑积水组发病后第7-9 d的脑脊液s Fas及第10-12 d的s Fas L浓度显著高于无脑积水组（均P〈0.05）。重度残疾组和植物生存组脑脊液s Fas、s Fas L浓度均显著高于恢复良好组和轻度残疾组（均P〈0.05）;植物生存组脑脊液s Fas L浓度还显著高于重度残疾组（P〈0.05）。结论 a SAH患者发病后脑脊液s Fas、s Fas L水平明显增高;其水平变化与慢性脑积水的发生关系不大,但与患者的预后有明显关系。Objective To explore the changes and relationships between the levels of cerebrospinal fluid（ CSF） s Fas / s Fas L and chronic hydrocephalus and prognosis in patients with aneurysmal subarachnoid hemorrhage（ a SAH）. Methods After collecting the CSF by lumbar puncture from 118 patients at different time points,the concentrations of s Fas and s Fas L in the CSF were measured using specific ELISA. Twelve patients who had fever undergoing lumbar puncture for exclusion of intracranial infection served as contols. Using GOS to evaluate the prognosis of the SAH patients. s Fas and s Fas L concentrations were compared within different groups. Results（ 1） Of118 patients,24 developed hydrocephalus.（ 2） CSF s Fas and s Fas L levels were higher in hydrocephalus group compared with non-hydrocephalus group,but the difference had significance only in days 7 to 9 and days 10 to 12 respectively.（ 3） s Fas and s Fas L concentrations in severe disability and persistent vegetative state group were significantly higher than good recovery and mild disability groups（ all P〈0. 05）,s Fas L concentrations in persistent vegetative state group were significantly higher than those of severe disability groups（ P〈0. 05）. Conclusions High concentrations of s Fas and s Fas L in the CSF after a SAH onset are not associated with the occurrence of chronic hydrocephalus. CSF levels of s Fas and s Fas L are associated with the outcome of the patients.

关 键 词：动脉瘤性蛛网膜下腔出血 SFAS SFASL 脑积水 预后 

分 类 号：R651[医药卫生—外科学]