蛛网膜下腔出血迟发性血管痉挛的研究

本研究采用注血所致狗的迟发性脑血管痉挛(DCVS),对SAH后DCVS进行研究。认为IAB(孵育动脉血)是主要致病因素。自由基损伤可能是DCVS发病关键环节之一,5—HT与DCVS无直接关系,Ach是基底动脉内皮依赖性血管舒张作用减弱或消失的主要原因。本文对61例SAH合并DCVS进行了分析,DCVS发病为60%,主要病因为颅内动脉瘤破裂,CT于基底池存在较多弥漫性高密度影时,可预示DCVS的发生,SAH再发者危险性更大。DCVS患者多病情重,死亡率高。     

内皮素与迟发性脑血管痉挛的关系

目的　探讨内皮素与蛛网膜下腔出血 (SAH)后迟发性脑血管痉挛 (DCVS)的关系。　　方法　采用免疫组化与放射免疫方法 ,观察了内皮素 1在SAH后DCVS时痉挛动脉分布的改变 ,测定了DCVS实验动物痉挛动脉内皮素 1的含量。　　结果　 (1 )DCVS组痉挛动脉除内皮细胞外 ,中层平滑肌细胞胞浆中含多量的内皮素 1免疫反应阳性颗粒。 (2 )DCVS组痉挛动脉内皮素 1的浓度为 (1 3 0 40± 1 0 6 0 )pg mg,显著高于对照组的 ( 8 1 40± 0 955)pg mg (P <0 0 1 )。　　结论　内皮素可能是迟发性脑血管痉挛一种重要致病物质。     

蛛网膜下腔出血患者血及脑脊液中D-二聚体的动态观察

目的探讨蛛网膜下腔出血(SAH)后血及脑脊液(CSF)中纤溶活性的变化规律.方法应用酶联免疫吸附试验(ELISA)双抗体夹心法检测SAH患者发病后0～3天(急性期)、4～9天(再出血高峰期)及14～21天(吸收期)血及CSF中D-二聚体(D-D)含量,并与正常对照组比较.结果 SAH后血及CSF中D-D水平显著增高,但随时间延长而显著降低,0～3天及4～9天显著高于对照组,14～21天与对照组无差异性;0～3天CSF中D-D水平显著高于血液中D-D水平.结论 SAH后血及CSF中纤溶活性急性期显著升高,随病程延长而迅速降低;急性期CSF 中纤溶活性升高比血液中更明显.     

蛛网膜下腔出血患者血清、脑脊液白细胞介素-6水平研究

目的探讨蛛网膜下腔出血(SAH)后血清、脑脊液(CSF)白细胞介素-6(IL-6)水平变化及临床意义.方法用放免法检测32例不同病因、不同时期、不同病情SAH患者血清及CSF中IL-6水平变化,并与对照组比较.结果SAH后血清及CSF中IL-6水平比对照组明显升高(P＜0.05).CSF中IL-6水平比血清中高,IL-6升高与病情轻重和出血量多少有关.结论IL-6可作为观察病情及迟发性脑血管痉挛(CCVS)的指标.     

SAH后血清IC、C3、C4水平与迟发性脑血管痉挛的临床意义

目的观察蛛网膜下腔出血(SAH)后迟发性脑血管痉挛(DCVS)的发生与免疫复合物(IC)及补体成分(C3、C4)变化的关系。方法采用比浊法，单向免疫扩散法，对137例SAH患者于发病1周内、第2周、第3周进行血清IC、C3、C4动态检测,根据临床症状、辅助检查结果分为DCVS组与无DCVS组，比较两组间不同病程免疫指标的变化。结果发现DCVS组于发病1周内IC、C3、C4水平高于无DCVS组，并持续2周，后随临床症状好转逐步降至正常范围。结论动态观察IC及补体成分，可作为预测DCVS的可能性和估价病情危重程度的指标，同时也为临床应用免疫抑制剂预防DCVS提供依据。     

蛛网膜下腔出血后IL-6增高

本文对12例蛛网膜下腔出血(SAH)病人的血清和脑脊液中的细胞因子IL-6,SIL-2R和CD8进行了研究。12例病人中,10例为自发性SAH,其中8例为动脉瘤性SAH;2例为创伤性SAH。结果:1.IL—6:血清中IL—6水平在SAH3天时有3例升高,1例第9天升高;脑脊液中在SAH后1～3天11例呈病理性增高,有8例于3～6天达高峰,6～9天始下降。2.SIL—2R:血清中8例有3例1～3天升     

蛛网膜下腔出血后迟发性脑血管痉挛40例临床分析

我院1990年以来收住的108例蛛网膜下腔出血(SAH)患者中,有40例(占37.0%)发生脑血管痉挛(DCVS),现报道如下。1　临床资料1.1　一般资料　本组男12例,女28例,年龄20～70岁,平均52.4岁。入院时按Hunt(1974)分级:级14人,级18人,级8人。SAH后出现DCVS时间2～21天,平均7.8天。其中第1周20例占(50.0%),第2周16例(40.0%),第3周4例(10.0%),以第1周发生者多。1.2　临床症状　SAH后再次出现意识障碍28例,精神症状14例,运动障碍30例,感觉障碍17例,持续发热32例,其中6例为39℃以上高热。经腰穿、CT及其他检查排除再出血、感染、水电酸碱平衡紊乱…     

刺五加对实验性蛛网膜下腔出血后脑血管痉挛及内皮素和降钙素基因相关肽的影响

目的探讨中药刺五加(AS)防治蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)的作用机制.方法采用犬枕大池二次注血制作实验性犬SAH后CVS动物模型.放免法测定SAH后30 min、2 d、4 d和7 d时血及脑脊液(CSF)中内皮素(ET)和降钙素基因相关肽(CGRP)含量.并于第二次注血后30 min静脉滴注AS注射液,以后每日1次(40 mL/d)至第7天,测定时间点同上.结果 AS组在第二次注血后2 d、4 d、7 d血浆及CSF中ET含量较对照组高,较单纯注血组低.而CGRP较对照组略低,较注血组高.结论刺五加可以通过抑制ET升高和CGRP降低而达到防治SAH后CVS的目的.     

重型颅脑创伤病人CSF中IL-6含量的变化及其临床意义

目的研究急性重型颅脑创伤(sTBI)病人脑脊液(CSF)中白细胞介素-6(IL-6)含量的变化及亚低温治疗对其影响与临床意义。方法80例急性sTBI患者(伤后6h内入院,GCS≤8分)随机分为亚低温(HT)组和常温(NT)组各40例,采用放射免疫法检测亚低温治疗前(伤后早期)、后不同时段CSF中IL-6的含量,同时对比两组病人的颅内压(ICP)、GlasgowOutcomeScale(GOS)计分指标并分析其间关系。结果急性sTBI病人伤后早期CSF中IL-6含量明显增高。与NT组病人比较,亚低温治疗后24h,HT组病人的ICP值和IL-6含量明显降低(P<0.05;P<0.05),并持续至复温后24h(P<0.01;P<0.01),而IL-6含量在伤后1个月时仍明显低于NT组(P<0.01)。HT组病人伤后6个月时的GOS计分明显高于NT组(P<0.05),即HT组病人的预后较好。结论sTBI病人急性期CSF中IL-6含量增高,亚低温可降低急性sTBI后的高ICP和明显抑制IL-6超表达,改善临床预后。     

钙拮抗剂防治蛛网膜下腔出血后的迟发性脑血管痉挛的观察

目的 :观察钙拮抗剂对蛛网膜下腔出血后迟发性脑血管痉挛 (DCVS)的疗效。方法 :对 66例蛛网膜下腔出血 (SAH)患者将其分为钙拮抗剂治疗组 ( 32例 )和常规治疗对照组 ( 34例 )。结果 :32例治疗组中发生DCVS的 5例 ,34例对照组中发生DCVS2 1例 (P <0 0 5) ;死亡人数治疗组 4例 ,对照组 7例 ,无显著差异 (P >0 0 5)。结论 :钙拮抗剂在DCVS的防治中有显著疗效。     

Indole amine deficiency in blood and cerebrospinal fluid from patients with human immunodeficiency virus infection

Twenty-four patients with human immunodeficiency virus (HIV) infection were investigated for possible changes in certain indole amine constituents in blood and cerebrospinal fluid (CSF). Albumin in serum was determined and used as a rough nutritional marker. Six of the 24 patients had acquired immunodeficiency syndrome AIDS, four had other clinical symptoms of HIV infection, and 14 had no apparent symptoms. The HIV-seropositive patients had significantly decreased tryptophan values; their blood concentrations were 28% lower and their CSF concentrations 30% lower than corresponding values in 14 healthy controls. The blood concentrations of 5-hydroxytryptamine (5-HT) were 50% lower, and the platelet content of 5-HT was 36% lower in HIV-infected individuals than in the control group. The most pronounced changes were invariably seen in the six cases with AIDS and in patients with a low number of CD4+ cells. No significant difference between controls and HIV-seropositive patients was detected in the mean CSF concentrations of 5-hydroxyindoleacetic acid (5-HIAA), although these levels were markedly reduced in four of the HIV patients. Neither was any significant difference seen between patients and controls in the serum concentrations of albumin.     

Serotoninergic system in dementia of the Alzheimer type. Abnormal forms of 5-hydroxytryptophan and serotonin in cerebrospinal fluid

Serotonin (5-HT), its precursor 5-hydroxytryptophan (5-HTP), and its major metabolite 5-hydroxyindoleacetic acid (5-HIAA) were measured in the cerebrospinal fluid (CSF) of 14 patients with dementia of the Alzheimer type (DAT) and in nine controls by high-performance liquid chromatography with a novel multisensor coulometric detection system. Concentrations of both 5-HT and 5-HIAA detected by this system were lower than the concentrations obtained using conventional amperometric detection. This difference was caused by coelution of compounds that could be resolved from 5-HT and 5-HIAA by the multisensor coulometric system. One of the coelution compounds, observed in DAT but not in control CSF, behaved like a partially oxidized 5-HT. A compound behaving like partially oxidized 5-HTP was also observed in DAT CSF. Concentrations of 5-HTP, 5-HT, and 5-HIAA were lower in DAT CSF than in a corresponding fraction of control CSF. These results indicate involvement of the serotoninergic system in DAT and might lead to development of a diagnostic test for DAT.     

Clinical, biochemical, and pharmacological observation in a patient with postasphyxic myoclonus: association to serotonin hyperactivity

Posthypoxic action myoclonus is usually associated with impaired serotonin (5-HT) neurotransmission but in some patients 5-HT precursors aggravate and 5-HT blockers improve action myoclonus. We studied a 65-year-old man who presented with action myoclonus following a prolonged episode of moderate hypoxia and severe hypercarbia. The myoclonus increased with 5-hydroxytryptophan (5-HTP) 1,200 mg/day plus carbidopa 300 mg/day and sodium salt of valproic acid (SVA) 800 mg/day, and improved with 1 mg of clonazepam (CNZ) in an intravenous bolus. Biochemical analysis of the cerebrospinal fluid (CSF) prior to any drug therapy did not reveal abnormalities in the levels of homovanillic acid (HVA) and methoxyhydroxyphenylglycol (MHPG) but 5-hydroxyindoleacetic acid (5-HIAA) levels were elevated in comparison with controls (33 versus 21 ng/ml). SVA therapy produced a moderate increase and 5-HTP plus carbidopa a threefold elevation of 5-HIAA in CSF and marked aggravation of action myoclonus. Methysergide (3 mg/day) totally suppressed myoclonus and decreased CSF 5-HIAA to undetectable levels. Methysergide also reduced CSF tryptophan to 40% of baseline levels. Discontinuation of methysergide and substitution by placebo was followed by reappearance of myoclonus. A partial and incomplete spontaneous remission of symptoms took place 7 months after the asphyxic episode. Action myoclonus and enhanced 5-HT neurotransmission may be present in patients in which acidosis reverses the effects of hypoxia on 5-HT neurotransmission.     

CSF monoamine patterns in pathological gamblers and healthy controls

Previous reports on compounds in the cerebrospinal fluid (CSF) of pathological gamblers have focused on disturbed NA, DA and 5-HT function in the central nervous system. We have analysed precursors, transmitters and transmitter metabolites in 3 x 6 ml of CSF obtained from one female and 11 male pathological gamblers and 11 healthy male controls lumbar punctured at the L4-5 level after 8 h of fasting without preceding strict bedrest. Pathological gamblers displayed lower CSF levels of tryptophan and 5-HT while the opposite was the case for 5-HIAA, tyrosine, DA, HVA, DOPAC and HMPG. In contrast to previous studies, the NA level did not differ between pathological gamblers and healthy controls. A disrupted CSF gradient was noted for tryptophan, 5-HT, DA, HVA, DOPAC, NA and HMPG, but only in pathological gamblers. A disrupted gradient was found for 5-HIAA in both pathological gamblers and healthy controls. The results are in line with the presence of altered indoleamine and catecholamine function in pathological gamblers as well as an altered CSF transport from the brain to the lumbar compartment in such gamblers.     

Serotonin and monoamine metabolites in cerebrospinal fluid in children: interrelationships and the influence of age, sex and precursor]

Cerebrospinal fluid and blood were taken from 15 non-neurologic children. Tryptophan(Trp), 5-HTP, 5-HT, 5-HIAA, HVA, MHPG in CSF, and 5-HT, free and total Trp(F-Trp and T-Trp) in serum were determined by HPLC method. Results showed that Trp, 5-HTP, 5-HT, 5-HIAA in CSF were positively correlated significantly. Good correlations were also found between F-Trp in serum and Trp in CSF (C-Trp), 5-HIAA and HVA, 5-HTP and MHPG. C-Trp, 5-HTP, 5-HT, 5-HIAA and HVA declined significantly with increasing age. MHPG was higher in male than in female children.     

Study of tryptophan metabolism via serotonin in cerebrospinal fluid of patients with noncommunicating hydrocephalus using a new endoscopic technique

By a recent minimally invasive neuroendoscopic technique, the cerebral ventricles have been reached in a quick, reliable, and harmless way, making possible the study of cerebrospinal fluid (CSF) of the lateral ventricles and, above all, the CSF adjacent to the walls of the third ventricle. Tryptophan, 5-hydroxytryptophan, serotonin (5-HT), and 5-hydroxyindoleacetic acid (5-HIAA) were measured in CSF by HPLC equipment. Twenty-six patients affected with noncommunicating hydrocephalus were enrolled in the study and, as controls, 28 subjects not suffering from any neurological disease. The concentrations of tryptophan were higher in right ventricular CSF than in lumbar CSF (P < 0.01). 5-HT was detectable in the CSF of the right ventricle of hydrocephalic patients. 5-HIAA was higher in right ventricular CSF than in cisternal and lumbar CSF (P < 0.01), both in controls and in hydrocephalic patients. However, there was a higher concentration of 5-HIAA in right ventricular (P < 0.05) and cisternal (P < 0.01) CSF in hydrocephalic patients in comparison with controls. In the CSF samples withdrawn during neuroendoscopy, 5-HT presented the highest concentrations in the pineal recess. The highest amounts of 5-HIAA were found in the choroid plexus, third and right ventricles, pituitary recess, and aqueduct, and the lowest in pineal recess, subarachnoid space, infundibulum, and interpeduncolar cistern. These results provide new insight into the fate of tryptophan and its metabolites via serotonin in the CSF and suggest the feasibility of the new neuroendoscopic technique for brain metabolic studies.     

抑郁症患者自杀与脑脊液单胺代谢产物的关系

目的：探讨抑郁症患者自杀与脑脊液单胺代谢产物之间的关系。方法：应用高效液相色谱法，测定24例抑郁症患者(自杀组10例，无自杀组14例)及25例对照组5-羟色胺(5-HT)代谢产物5-羟吲哚乙酸(5-HIAA)，去甲肾上腺素(NE)代谢产物3-甲基-4-羟苯乙二醇(MHPG)及多巴胺(DA)代谢产物高香草酸(HVA)的浓度。结果：抑郁症自杀组5-HIAA浓度显著低于对照组，男性自杀组5-HIAA浓度、HVA浓度和HVA／MHPG比值均显著低于男性对照组，女性则无显著差异：结论：抑郁症患者自杀可能与5-HT和DA功能低下以及DA和NE之间的关系改变有关。     

Effects of short-term serotonin depletion on the efficacy of serotonin neurotransmission: electrophysiological studies in the rat central nervous system

The effects of short-term serotonin (5-HT) depletion by p-chlorophenylalanine (PCPA) on the firing activity of dorsal raphe nucleus 5-HT neurons, on the responsiveness of dorsal hippocampus pyramidal neurons to microiontophoretically applied 5-HT and on the efficacy of the electrical stimulation of the ascending 5-HT pathway in suppressing the firing activity of CA3 dorsal hippocampus pyramidal neurons were assessed in chloral hydrate-anesthetized rats. PCPA (250 mg/kg/day i.p. for 2 days) reduced the 5-HT content of the dorsal hippocampus by 90%. However, the number of spontaneously active 5-HT neurons per microelectrode trajectory through the dorsal raphe or their average rate of firing was unaltered. The effect of afferent 5-HT pathway stimulation was reduced in only 40% of treated rats, whereas the sensitivity of CA3 pyramidal neurons to microiontophoretic 5-HT was not modified. The function of the terminal 5-HT autoreceptor was assessed using methiothepin, an autoreceptor antagonist. Methiothepin (1 mg/kg, i.v.) significantly enhanced the efficacy of the stimulation in PCPA-treated rats, although the degree of enhancement was much less than in controls. A greater reduction of the effectiveness of the stimulation was obtained by increasing the dose of PCPA (350 mg/kg/day i.p. for 2 days). This regimen reduced the 5-HT content of the dorsal hippocampus by 95%. In these rats, the sensitivity of the terminal 5-HT autoreceptor was assessed by increasing the frequency of the stimulation from 1 to 5 Hz. This procedure reduced to a similar extent the efficacy of the stimulation in treated and control rats, suggesting that the reduced effectiveness of methiothepin in enhancing 5-HT synaptic transmission in PCPA-treated rats is due to a lower degree of activation of the terminal 5-HT autoreceptor. The present results showing that the 350 mg/kg/day regimen of PCPA, but not the 250 mg/kg/day regimen, reduced the efficacy of the stimulation of the ascending 5-HT pathway suggest that a greater than 90% depletion is required to affect 5-HT neurotransmission significantly. The reduced level of activation of terminal 5-HT autoreceptors in rats treated with the lower dose of PCPA may facilitate the release of the remaining 5-HT per stimulation-triggered action potential, ensuring a virtually unaltered synaptic efficacy.     

Changes in CSF tryptophan metabolite levels in infantile spasms]

Cerebrospinal fluid (CSF) from 6 cases of asymptomatic infantile spasms (IS) (mean age, 6.1 months) was collected before and after treatment with adrenocorticotropic hormone (ACTH). The concentration of CSF tryptophan (TRP) metabolites was analyzed using HPLC and compared to the metabolite concentration in CSF from 10 age-matched controls (mean age, 6.7 months). Levels of CSF serotonin (5-HT), 5-hydroxyindoleacetic acid (5-HIAA), and kynurenine (KYN) at pretreatment were significantly lower in IS patients compared to controls (p < 0.05). In contrast, the levels of CSF 3-hydroxykynurenine (3-OHKY) before ACTH treatment were significantly higher in IS patients than in controls (p < 0.05). After the treatment, significant increases in 5-HIAA and decreases in KYN and 3-OHKY levels (p < 0.05) were observed in CSF of infants whose seizures were eliminated by ACTH. These findings suggested that the presence of seizures in IS was associated with a significant decrease in serotonergic activity, or that the turnover in the direction of 3-OHKY was altered. The possibility that elimination of seizures by ACTH might be related to decreased production of kynurenine metabolites was discussed.     

兔蛛网膜下腔出血后迟发性脑血管痉挛程度的分级标准判 定

目的 探讨兔迟发性脑血管痉挛模型制作方法及脑血管痉挛程度的分级标准。方法 应用两次枕大池注血法建立兔迟发型脑血管痉挛模型,分别在造模后1,3,7 d观察动物模型的行为学后,行DSA造影;然后取基底动脉进行HE染色和扫描,透射电镜观察。结果 造模后3,7 d,出现明显行为和神经功能异常,血管造影显基底动脉中度-重度痉挛;HE染色示基底动脉血管管壁增厚,管腔变小,血管明显痉挛;透射电镜观察显示,造模后3 d基底动脉内皮细胞核出现凋亡小体,线粒体空泡样变性,造模7 d基底动脉内皮线粒体肿胀溶解,包浆空泡样变性。结论 应用两次枕大池注血法能够重复建立成功的兔迟发型脑血管痉挛模型,在此基础上可以制定脑血管痉挛程度的判定标准（4级分法）,有利于科学地综合评价迟发型脑血管痉挛模型。