颅底肿瘤术后脑脊液中降钙素基因相关肽的动态变化与迟发性脑血管痉挛的相关性分析  

Relationships between dynamic variety of CGRP and delayed cerebral vasospasm after resection of skull base tumor

作　　者：董志强[1] 李强[1] 梁文涛[1] 潘亚文[1] 

机构地区：[1]兰州大学第二医院神经外科医学中心,甘肃兰州730030

出　　处：《中国耳鼻咽喉颅底外科杂志》2015年第4期284-286,291,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的 分析颅底肿瘤术后脑脊液中降钙素基因相关肽（calcitonin gene-related peptide,CGRP）的动态变化规律与术后迟发性脑血管痉挛（delayed cerebral vasospasm,DCVS）的相关性。方法 选择诊断明确的颅底肿瘤患者43例,术后行腰椎穿刺术留取脑脊液标本,测定脑脊液中CGRP的含量;手术前1 d和术后第1、3、5、7、10和14天用经颅超声多普勒（TCD）动态监测双侧颈内动脉、双侧大脑前和中动脉的流速和频谱,判断是否发生DCVS。结果 术后第3、5、7、10、14天DCVS发生率有明显差异（χ2=21.34,P〈0.05）,其中第7天DCVS发生率（63.5%）最高。术后发生DCVS的患者第3天脑脊液中CGRP水平即有明显降低,第7~10天降到最低,而后逐渐上升;中、重度DCVS组CGRP水平明显低于对照组和无DCVS组（P〈0.05）,重度DCVS组CGRP水平低于轻度和中度DCVS组（P〈0.05）;颅底肿瘤术后脑脊液中CGRP的水平与术后TCD监测的大脑中动脉平均血流速度（MCA MFV）呈负相关（r=-0.187,P〈0.05）。结论 颅底肿瘤术后患者脑脊液中CGRP水平的降低参与了术后DCVS的发生,其含量与TCD监测的MCA MFV呈负相关,与术后DCVS的发生呈负相关,并可预测DCVS的严重程度和判断预后。Objective To explore the dynamic changes of calcitonin gene-related peptide （CGRP） in cerebrospinal fluid （CSF） and the relationship between CGRP and delayed cerebral vasospasm （DCVS） after resection of skull base tumor. Methods 43 patients with definitive diagnosis of skull base tumors were included. After resection of tumor, lumbar puncture was performed to get CSF and CGRP levels in CSF were measured. The velocities and spectra of bilateral internal carotid artery, anterior cerebral artery and middle cerebral artery were monitored by TCD in all the patients at one day before and 1, 3, 5, 7, 10 and 14 days after operation. Results After operation, CGRP levels of CSF were markedly decreased in patients with DCVS on the 3rd day, and reached nadir within 7 to 10 days, and then got increased gradually. The levels of CGRP in groups with medium and severe DCVS were significantly lower than those of the control group and the group without DCVS （P 〈 0.05）, while those of the severe DCVS group was lower than those of mild and medium DCVS groups（P 〈0.05 ）. The level of CGRP in CSF was negatively correlated with the mean flow velocity of middle cerebral artery（ MCA MFV） monitored by TCD （r = -0. 187 ,P 〈 0.05 ）. Conclusions Decrease of CGRP level in CSF might be involved in the pathogenesis of the operation-associated DCVS. The level of CGRP in CSF is negatively correlated with the MCA MFV and also negatively correlated with the operation-related DCVS. CGRP level in CSF can be used for the evaluation of degree of postoperative DCVS and prognosis of the patients with DCVS.

关 键 词：颅底肿瘤 脑脊液 降钙素基因相关肽 经颅超声多普勒 脑血管痉挛 迟发性 

分 类 号：R739.91[医药卫生—肿瘤]