老年人蛛网膜下腔出血诊疗方法的探讨

目的 探讨老年人自发性蛛网膜下腔出血的诊断和治疗。方法 选择本院1993年6月至1999年6月收治的60岁以上老年人自发性蛛网膜下腔出血共64例,男26例,女38例,均行头颅CT证实蛛网膜下腔出血（不合并颅内血肿）;腰穿呈血性脑脊液。40例行DSA检查,动脉瘤31例、动静脉畸形5例、Moyamoya病1例、动脉硬化3例。内科保守治疗29例,血管内治疗25例,手术夹闭及切除病灶10例。结果 内科保守治疗组死亡8例（8／29）,血管内治疗死亡2例（2／25）,手术夹闭及切除病灶组死亡1例（1／10）。结论 老年人自发性蛛网膜下腔出血以动脉瘤破裂常见,DSA是其病因诊断最有价值的手段;动脉瘤破裂至自发性蛛网膜下出血以血管内治疗及手术为有效的治疗方法。     

蛛网膜下腔出血急性期CT及临床因素与继发脑损害的关系

目的探讨蛛网膜下腔出血(SAH)急性期CT表现及临床因素与继发脑损害(再出血、迟发性脑梗死、脑积水)的相关因素,为防治提供参考依据。方法分析SAH在颅内的分布情况、年龄、性别、血压、血钠、脑血管造影及治疗方法的选择等与SAH继发脑损害的关系。结果继发脑损害均与CT显示积血阳性、分布区域不同和低钠血症有关,其中再出血和脑梗死以脑表面有积血块或脑室有血者发生率较高(均P＜0.01),预后也较差。脑血管有病变或CT显示SAH者发生再出血或脑梗死较多。结论SAH急性期CT及临床相关因素对其继发脑损害的预测有一定临床意义,并可据此进行防治。     

Inflammatory cytokine cascade released by leukocytes in cerebrospinal fluid after subarachnoid hemorrhage

Abstract

Subarachnoid hemorrhage (SAH) elicits an inflammatory response in the subarachnoid space, which is mediated by the release of various cytokines. To assess their involvement in post-hemorrhagic complications, we determined the source and time-course of the release of inflammatory cytokines and acute-phase proteins in cerebrospinal fluid (CSF) following SAH. Concentrations of interleukin (IL)-1β, IL-6, transforming growth factor-β1 (TGF-β1) and C-reactive protein (CRP) in CSF of 36 patients with SAH were measured by enzyme-linked immunoabsorbent assay (ELISA). Floating cells collected from the CSF were centrifuged four to six days after SAH, and examined immunohistochemically. Intracellular IL-1β and IL-6 were examined by flow cytometric analysis. The molecular weight of TGF-β1 in CSF of 30 patients was examined by Western blot analysis. The TGF-β1 levels of patients who had undergone ventriculoperitoneal (VP) shunt (n = 19) was significantly higher than nonshunt group (n = 16). The CRP levels of VP shunt group was significantly higher than nonshunt group. IL-6 concentration was maximal within day 0-1 and it was secreted by neutrophils and monocytes. ELISA showed consistently low levels of IL-1β, whereas a proportion of monocytes and lymphcytes were IL-1β-positive by flow cytometric analysis. TGF-β1 levels were also maximal on day 0-1 according to ELISA, although it tended to be in the inactive form derived from platelets. A 25 kDa band of TGF-1 was detectable for at least 13 days after SAH, which may have been secreted in part by neutrophils and monocytes. CRP levels in CSF peaked on day 2-3. The present results suggest that leukocytes induced by SAH play an important role in post-hemorrhagic inflammation in the subarachnoid space by releasing IL-6 and TGF-β1. The CRP and TGF-β1 levels in CSF are strongly concerned with communicating hydrocephalus after SAH. [Neurol Res 2001; 23: 724-730]     

Apolipoprotein E polymorphism and neuropsychological outcome following subarachnoid haemorrhage

OBJECTIVES: To investigate the association between APOE genotype and cognitive and emotional outcome following spontaneous subarachnoid haemorrhage (SAH). MATERIALS AND METHODS: Neuropsychological assessments were conducted with 70 SAH survivors derived from a consecutive series of neurosurgical admissions. Outcomes, including cognitive tests, health questionnaires and Glasgow Outcome Scale at a mean of 16 months after SAH, were compared with presence or absence of the epsilon4 allele. RESULTS: There was no evidence that SAH survivors possessing the epsilon4 allele had poorer outcome. The only suggestion of an association between the epsilon4 allele and outcome was in a subgroup of patients with a Fisher grade 4 haemorrhage, although this trend did not reach statistical significance. CONCLUSIONS: Overall, possession of the APOE epsilon4 allele is not significantly associated with neuropsychological outcome following SAH. However, there may be an effect amongst those with a Fisher grade 4 haemorrhage.     

人脐静脉内皮细胞内S-腺苷同型半胱氨酸升高与MCP-1表达的关系

目的探讨胞内S-腺苷同型半胱氨酸(S-adenosylhomocysteine,SAH)聚集损伤血管内皮细胞的分子基础,为阐明膳食高蛋氨酸摄入促进心血管疾病的病理机制提供实验依据。方法以永生化的人脐静脉内皮细胞(HUVEC)为研究对象,经不同浓度的S-腺苷同型半胱氨酸水解酶(SAHH)强效抑制剂3-deazaadenosine(DZA)处理24,48或72 h后,利用酶联免疫吸附测定法(ELISA)测定HUVEC内炎性分子单核细胞趋化蛋白-1(MCP-1)的含量,荧光定量-PCR法(qRT-PCR)检测MCP-1 mRNA的相对表达量,甲基化特异PCR法(MSP)分析MCP-1基因启动子甲基化状态。结果HUVEC经DZA处理后,与正常对照相比,胞内MCP-1的含量升高,mRNA的相对表达量上调,但其启动子甲基化方式并不发生改变。结论内皮细胞SAH升高上调MCP-1的表达可能是膳食高蛋氨酸摄入促进心血管疾病的分子机制,但这种作用与MCP-1基因启动子的甲基化状态无关。     

微透析技术在蛛网膜下腔出血中的临床研究

微透析技术可持续测量活体脑细胞外液的生化物质浓度，其应用已从动物实验发展到临床研究。近几年国外应用微透析技术对动脉瘤性蛛网膜下腔出血（ＳＡＨ）病人进行持续监测，用来研究脑血管痉挛、脑缺血或延迟性缺血性神经功能障碍时细胞外液的生化物质改变，在兴奋性氨基酸、能量代谢物质、甘油及ＮＯ代谢物等方面积累了大量的临床研究资料。本文对微透析技术的临床应用现状及其在ＳＡＨ中的临床研究成果进行综述。