颅底肿瘤术后脑脊液中ET-1的动态变化与脑血管痉挛的相关性研究

目的探讨颅底肿瘤术后脑脊液中内皮素-1（ET-1）的动态变化规律及其与脑血管痉挛（CVS）的相关性。方法颅底肿瘤病人33例，在术后第3、5、7、10和14天用放免法测定脑脊液中ET-1的含量；手术前1天和术后第1、3、5、7、10和14天用经颅多普勒超声动态监测双侧颈内动脉、双侧大脑前动脉和中动脉的血流速度。结果术后发生CVS的患者第3天脑脊液中ET-1水平即升高，第7天达到高峰，而后逐渐下降；术后第5、7和10天，中、重度CVS组ET-1水平明显高于对照组（P〈0.05），术后第7和10天，重度CVS组ET-1水平高于轻、中度CVS组和无CVS组（P〈0.05）；术后脑脊液中ET-1的水平与大脑中动脉平均血流速度呈正相关（r=0.635，P〈0.01）。结论颅底肿瘤术后患者脑脊液中ET-1水平的升高参与了术后CVS的发生，且其变化与术后CVS呈正相关，提示其含量可预测颅底肿瘤病人术后CVS的严重程度和预后。

Dynamic Change in Endothelin-1 in Cerebrospinal Fluid and Its Relationship with Cerebral Vasospasm after Resection of Skull Base Tumors

Objective To explore the dynamic changes in Endothelin-1 （ET-1） level in cerebrospinal fluid （CSF） and the relationship between ET-1 and cerebral vasospasm （CVS） after the resection of skull base tumors. Methods ET-1 levels in CSF which was obtained by lumbar puncture after the surgery were determined in 33 patients with skull base tumors. The blood flow velocity of bilateral internal carotid arteries, anterior cerebral arteries and middle cerebral arteries （MCA） were monitored by transcranial Doppler sonography before and after the operation. Results In the patients with skull base tumors CSF ET-1 levels increased 3 days after the operation, reached the peaks 7 days after the operation, and then decreased gradually. CSF ET-1 levels were significantly higher in middle and severe CVS groups than those in the control group 5, 7 and 10 days after the operation （P〈0.05）. CSF ET-1 levels were significantly higher in severe CVS group than those in mild CVS, middle CVS and no CVS groups 7 and 10 days after the operation （P〈 0.05）. CSF ET-1 level was positively correlated with the MCA mean blood flow velocity after the resection of skull base tumor （r=-0.635, P〈0.01）. Conclusions It is suggested that the increase in CSF ET-1 levels may be related to the pathogenesis of CVS afterthe operation in the patients with skull base tumors. That CSF ET-1 level is positively correlated with the MCA mean blood flow velocity after the operation suggests that CSF ET-1 levels can be used to assess the severity of CVS and the prognosis in the patients with skull base tumors undergoing the surgery.