中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2012年
9期
997-1002
,共6页
钱进先%李磊%陆士奇%陈罡%赵益明
錢進先%李磊%陸士奇%陳罡%趙益明
전진선%리뢰%륙사기%진강%조익명
蛛网膜下腔出血%动脉瘤性蛛网膜下腔出血%vWF%ADAMTS13%迟发性脑缺血%脑血管痉挛%预后
蛛網膜下腔齣血%動脈瘤性蛛網膜下腔齣血%vWF%ADAMTS13%遲髮性腦缺血%腦血管痙攣%預後
주망막하강출혈%동맥류성주망막하강출혈%vWF%ADAMTS13%지발성뇌결혈%뇌혈관경련%예후
Subarachnoid hemorrhage%Aneurysm subarachnoid hemorrhage%von Willebrand factor%ADAMTS13%Delayed cerebral ischemia%Cerebral vasospasm%Prognosis
目的 了解血管性假血友病因子(vWF)与ADAMTS13在动脉瘤性蛛网膜下腔出血患者(aneurysmal subarachnoid hemorrhage,aSAH)中的动态变化及意义.方法 采用回顾性分析方法,将苏州大学附属第一医院神经外科2010年4月至2011年4月收治的动脉瘤性蛛网膜下腔出血患者29例,分成迟发性脑缺血组(DCI组)和非迟发性脑缺血组(无DCI组)、脑血管痉挛组(CVS组)和无痉挛组(无CVS组)、预后良好组和预后不良组,并引入正常健康体检者20例作为对照组.所有入选患者均行CT、DSA和(或)CTA确诊为颅内动脉瘤破裂致蛛网膜下腔出血.排除标准:(1)入院时发病已超过72 h或即将死亡患者；(2)在外院已接受手术、介入或内科保守治疗患者；(3)正在使用抗血小板药物如阿司匹林、氯吡格雷,或其他抗凝药物如华法林等；(4)有血液系统疾病、肝肾功能不全、近期有感染性疾病、孕期患者.分别在SAH后第1天、第4天、第10天收集静脉血,使用ELISA方法检测vWF抗原和ADAMTS13活性,观察其动态变化,TCD检测大脑中动脉的血流速度(VMCA),出院时行GOS预后评分.使用SPSS 13.0统计软件进行统计学处理,计量资料以均数±标准差((x)±s)表示,并行t检验,多组比较采用方差分析.以P ＜0.05为差异有统计学意义.结果 血浆vWF水平在DCI组、CVS组及预后不良组第1天、第4天、第10天3个时间点均高于健康对照组,DCI组与无DCI组相比在第1天、第4天时间点组间比较差异具有统计学意义(P＜0.05),在第4天、第10天,CVS组与无CVS组,预后良好组与预后不良组组间比较差异具有统计学意义(P＜0.01).DCI组与预后不良组在T1时间点血浆ADAMTS13活性显著下降；而在是否发生CVS患者之间血浆ADAMTS13活性差异无统计学意义.结论 早期血浆vWF水平升高、ADAMTS13活性下降与DCI发生有关,并日早期ADAMTS13活件下降与预后相关.
目的 瞭解血管性假血友病因子(vWF)與ADAMTS13在動脈瘤性蛛網膜下腔齣血患者(aneurysmal subarachnoid hemorrhage,aSAH)中的動態變化及意義.方法 採用迴顧性分析方法,將囌州大學附屬第一醫院神經外科2010年4月至2011年4月收治的動脈瘤性蛛網膜下腔齣血患者29例,分成遲髮性腦缺血組(DCI組)和非遲髮性腦缺血組(無DCI組)、腦血管痙攣組(CVS組)和無痙攣組(無CVS組)、預後良好組和預後不良組,併引入正常健康體檢者20例作為對照組.所有入選患者均行CT、DSA和(或)CTA確診為顱內動脈瘤破裂緻蛛網膜下腔齣血.排除標準:(1)入院時髮病已超過72 h或即將死亡患者；(2)在外院已接受手術、介入或內科保守治療患者；(3)正在使用抗血小闆藥物如阿司匹林、氯吡格雷,或其他抗凝藥物如華法林等；(4)有血液繫統疾病、肝腎功能不全、近期有感染性疾病、孕期患者.分彆在SAH後第1天、第4天、第10天收集靜脈血,使用ELISA方法檢測vWF抗原和ADAMTS13活性,觀察其動態變化,TCD檢測大腦中動脈的血流速度(VMCA),齣院時行GOS預後評分.使用SPSS 13.0統計軟件進行統計學處理,計量資料以均數±標準差((x)±s)錶示,併行t檢驗,多組比較採用方差分析.以P ＜0.05為差異有統計學意義.結果 血漿vWF水平在DCI組、CVS組及預後不良組第1天、第4天、第10天3箇時間點均高于健康對照組,DCI組與無DCI組相比在第1天、第4天時間點組間比較差異具有統計學意義(P＜0.05),在第4天、第10天,CVS組與無CVS組,預後良好組與預後不良組組間比較差異具有統計學意義(P＜0.01).DCI組與預後不良組在T1時間點血漿ADAMTS13活性顯著下降；而在是否髮生CVS患者之間血漿ADAMTS13活性差異無統計學意義.結論 早期血漿vWF水平升高、ADAMTS13活性下降與DCI髮生有關,併日早期ADAMTS13活件下降與預後相關.
목적 료해혈관성가혈우병인자(vWF)여ADAMTS13재동맥류성주망막하강출혈환자(aneurysmal subarachnoid hemorrhage,aSAH)중적동태변화급의의.방법 채용회고성분석방법,장소주대학부속제일의원신경외과2010년4월지2011년4월수치적동맥류성주망막하강출혈환자29례,분성지발성뇌결혈조(DCI조)화비지발성뇌결혈조(무DCI조)、뇌혈관경련조(CVS조)화무경련조(무CVS조)、예후량호조화예후불량조,병인입정상건강체검자20례작위대조조.소유입선환자균행CT、DSA화(혹)CTA학진위로내동맥류파렬치주망막하강출혈.배제표준:(1)입원시발병이초과72 h혹즉장사망환자；(2)재외원이접수수술、개입혹내과보수치료환자；(3)정재사용항혈소판약물여아사필림、록필격뢰,혹기타항응약물여화법림등；(4)유혈액계통질병、간신공능불전、근기유감염성질병、잉기환자.분별재SAH후제1천、제4천、제10천수집정맥혈,사용ELISA방법검측vWF항원화ADAMTS13활성,관찰기동태변화,TCD검측대뇌중동맥적혈류속도(VMCA),출원시행GOS예후평분.사용SPSS 13.0통계연건진행통계학처리,계량자료이균수±표준차((x)±s)표시,병행t검험,다조비교채용방차분석.이P ＜0.05위차이유통계학의의.결과 혈장vWF수평재DCI조、CVS조급예후불량조제1천、제4천、제10천3개시간점균고우건강대조조,DCI조여무DCI조상비재제1천、제4천시간점조간비교차이구유통계학의의(P＜0.05),재제4천、제10천,CVS조여무CVS조,예후량호조여예후불량조조간비교차이구유통계학의의(P＜0.01).DCI조여예후불량조재T1시간점혈장ADAMTS13활성현저하강；이재시부발생CVS환자지간혈장ADAMTS13활성차이무통계학의의.결론 조기혈장vWF수평승고、ADAMTS13활성하강여DCI발생유관,병일조기ADAMTS13활건하강여예후상관.
Objective To study the clinical values of dynamic changes of yon Willebrand factor (vWF) and ADAMTS13 (a disintegrin and metalloprotease with thrombospondin repeats-13 ) in aneurysmal subarachnoid hemorrhage. Methods Twenty-nine patients with aneurysmal subarachnoid hemorrhage admitted to Department of Neurosurgery from April 2010 through April 2011 were enrolled for retrospective study.They could be categorized into 3 sets of grouping:delayed cerebral ischemia group ( DCI group) and non-delayed cerebral ischemia group ( no DCI group ),cerebral vasospasm group ( CVS group ) and no vasospasm group (no CVS group),and good prognosis group and poor prognosis group,and another 20 healthy subjects as control group.All patients were examined with CT,DSA,or/and CTA to identify the intracranial subarachnoid hemorrhage resulted from aneurysm rupture.The exclusion criteria included:(1)the time from onset to admission was longer than 72 hours or patient was in imminent danger of death; (2)patients had surgery,interventiona] or conservative treatment outside the hospital; (3) patients were under the treatment of antiplatelet medicine such as aspirin,clopidogrel,or other anticoagulants such as warfarin,etc ; (4) patients had blood diseases,impaired kidney or liver function,pregnant,or with recent infections.Venous blood were taken one day,4 days and 10 days after SAH to determine plasma concentrations of ADAMTS13 and vWF by using enzyme-linked immunosorbent assay (ELISA). Transcranial Doppler ultrasonography (TCD) was used to measure mean blood flow velocity of middle cerebral artery (VMCA).Glasgow outcome scale (GOS) score was measured before discharge. Data were analyzed by using SPSS version 13.0 software. Results The levels of vWF were significantly higher in DCI group,CVS group and poor prognosis group compared with those in the control group 1 day,4 days and 10 days after SAH.There were differences in vWF between DCI group and no DCI group 1 day and 4 days after SAH ( P ＜ 0.05 ).There were significantly differences in vWF between CVS group and no CVS group,and between good prognosis group and poor prognosis group 4 days and 10 days after SAH ( P ＜ 0.01 ).In DCI group and poor prognosis group,the level of plasma ADAMTS13 was significantly lower 1 day after SAH than that in the normal control group (P ＜0.01) and in the no DCI group (P ＜0.O1 ); and there were no differences in ADAMTS13 between CVS group and no CVS group.Conclusions In the early stage,the increase in plasma vWF and decrease in ADAMTS13 activity are associated with DCI,and the decrease in ADAMTS13 activity can be used to predict the outcome.
