脑脊液溶血磷脂酸含量与蛛网膜下腔出血后脑血管痉挛的关系

目的:观察蛛网膜下腔出血(SAH)患者脑脊液溶血磷脂酸(LPA)含量动态变化的特点及其与脑血管痉挛(CVS)的关系,探索CVS的发病机制.方法:选取经临床和辅助检查确诊的SAH患者67例,分别于发病后24 h、7 d、14 d和28 d测定脑脊液LPA含量,并与对照组进行比较,同时观察LPA含量与CVS在时程上的相关性.结果:67例SAH患者中共有29例(43.3%)发生CVS,平均发生时间为6.6 d.发病24 h时,SAH患者脑脊液LPA含量与对照组无显著差异;发病7 d时显著高于对照组(P＜0.001);发病14 d时显著高于对照组(P＜0.01),但显著低于发病7 d时(P＜0.01);发病28 d时降至基线水平,与对照组无显著差异.发病24 h时,CVS组脑脊液LPA含量与无CVS组无显著差异,发病7 d时显著高于无CVs组(P＜0.001),发病14 d时仍显著高于无CVS组(P＜0.01);发病28 d时两组之间无显著差异.结论:SAH患者脑脊液LPA水平在发病后7～14 d显著升高,并且在时程上与CVS发生显著关联.检测脑脊液12A含量对预测CVS的发生可能具有重要意义.

Relationship Between Lysophosphatidic Acid Levels in Cerebrospinal Fluid and Cerebral Vasospasm After Subarachnoid Hemorrhage

Objective: To observe the characteristics of dynamic changes of lysophosphatidic acid (LPA) levels in cerebrospinal fluid (CSF) in patients with subarachnoid hemorrhage (SAH) and its relationship with cerebral vasospasm (CVS) and to explore the pathogenesis of CVS. Methods: Sixty-seven patients with SAH diagnozed by clinical and accessory examinations were selected. The LPA levels in CSF were measured at 24 hours, day 7,14, and 28 respectively after the onset of symptoms,and they were compared with a control group. The correlation between LPA levels and CVS on the time course was also observed at the same time. Results: Of the 67 patients with SAH, a total of 29 patients (43.3%) occurred CVS, the average time of occurrence was 6. 6 days. There was no significant difference between the LPA levels in CSF in patients with SAH and the control group at 24 hours after the onset of symptoms; they were significantly higher than the control group at day 7 (P ＜0. 001); they were significantly higher than the control group at day 14 (P ＜ 0. 001), but they were significantly lower than those at day 7 (P ＜ 0. 01); they decreased to baseline at day 28, and there was significant difference compared with the control group. There was no significant difference between the LPA levels in the CVS group and those in the non-CVS group at 24 hours, they were significantly higher than those in the non-CVS group at day 7 (P ＜0. 001), they were still significantly higher than those in the non-CVS group at day 14 (P ＜0. 01); and there was no significant difference between the 2 groups at day 28. Conclusions: The LPA levels in CSF in patients with SAH increased significantly from day 7 to day 14 after the onset of symptoms, and they had obvious association with CVS on the time course. The detection of the LPA levels in CSF may have important significance in predicting the occurrence of CVS.