颅底肿瘤术后血浆内皮素-1的动态变化及其与脑血管痉挛的相关性研究

目的:研究颅底肿瘤术后血浆内皮素-1(ET-1)水平的动态变化,探讨其在术后并发脑血管痉挛(CVS)时的作用机制。方法:根据是否合并CVS,将34例颅底肿瘤术后患者分为症状性脑血管痉挛组、无症状脑血管痉挛组和非痉挛组。采用放射免疫法测定术后不同时点血浆ET-1的浓度,同时动态行经颅多普勒(TCD)检查判定患者CVS情况。同期选择10例健康成人进行对照研究。结果:1颅底肿瘤术后1d内血浆ET-1水平开始升高,5～7d达高峰,随后含量又逐步降低,14d时接近正常水平。2术后3组患者血浆ET-1水平均高于正常组,痉挛组血浆ET-1水平高于非痉挛组(P<0.01),症状性痉挛组高于无症状痉挛组(P<0.01)。3术后5～7d时CVS患者达最高峰,14d又明显减少。4术后7dCVS与血浆ET-1水平呈明显正相关(r=0.521,P=0.002)。结论:颅底肿瘤术后血浆ET-1升高可能是引起CVS的重要因素,可作为术后CVS的一种预测指标。

Study on dynamic change of endothelin-1 and its correlation with cerebral rasospasm after resection of skull base tumors

Objective:To study the changes of Endothelin-1(ET-1)in plasma of cerebral vasospasm(CVS)after resection of skull base tumors and its mechanism.Methods:34 cases were divided into symptomatic cerebral vasospasm group,asymptomatic cerebral vasospasm group and nonvasospasm group after resection of skull base tumors.The blood specimen was obtained from 34 patients on 1,3,5,7and 14 days after resection of skull base tumors.The concentration of ET-1 was detected by radioimmunoassay,meanwhile,TCD were recorded.10 cases normal adult served as control.Results:①Level of ET-1 in plasma elevated from the 1st day after resection of skull base tumors,with peak levels on the 5rd day to the 7th day,then decreased gradually and nearly recoverd on the 14th day.②Level of ET-1 in plasma of three groups were higer than those in normal adult groups.Level of ET-1 in plasma of cases in vasospasm groups were higer than those in nonvasospasm groups(P<0.01).Level of ET-1 in plasma of cases in symptomatic cerebral vasospasm groups were higer than those in asymptomatic cerebral vasospasm groups(P<0.01).③ CVS increased obviously at the 3rd day,with peak levels on the 5th day to the 7th day and recoverd obviously at the 14th day.④On the 7rd day,there was significant positive correlation between CVS and ET-1 levelchanges(r=0.521,P=0.002).Conclusion:The elevation of ET-1 in plasma was an critical reason for CVS after resection of skull base tumors,and may become a predictive indexs of CVS.