急性脑卒中患者血浆内皮素24h节律性变化

背景脑卒中的发病有早晨高、晚上低的早晚规律变化,而脑血栓患者血浆内皮素浓度的变化及与脑血栓发病之间的关系尚不十分清楚.目的探讨血浆内皮素水平对脑血栓急性期患者24 h内动态变化规律及其与发病的相关性.设计病例-对照实验.单位青岛大学医学院附属医院放免中心和检验科联合进行课题研究.对象选择2002-01/2003-01在青岛大学医学院附属医院神经内科住院脑血栓患者32例,男20例,女12例;平均年龄(61.5±4.1)岁.既往合并糖尿病和高血压史者10例,单纯有高血压史者8例,糖尿病史者1例,无高血压、糖尿病史者13例.同期选择在本院健康查体者30例为对照组,男13例,女17例;平均年龄(58.1±6.25)岁.所有参加者对本实验知情同意. 方法采用放射免疫分析对32例脑血栓患者和20例健康人在200,800,1400,2000时,测定其血浆内皮素水平的动态变化.主要观察指标①脑血栓组与对照组24 h内4个时间点血浆内皮素水平.②有无病史的脑血栓患者24 h内4个时间点血浆内皮素水平.结果参加实验的32例脑血栓患者和30例对照组血样检测结果全部进入统计分析.①脑血栓患者昼夜血浆内皮素水平明显高于对照组(t=29.1～30.5,P＜0.001),在24 h内200内皮素水平最低(69.96±3.92)ng/L,800最高(78.55±3.80)ng/L,(t=5.67,P＜0.01).②有高血压和糖尿病病史的脑血栓患者24 h内(200,800,1400,2000)的内皮素水平均显著高于无高血压,糖尿病病史者(73.28±7.89),(64.52±5.29)ng/L;(82.39±8.62),(75.81±5.14)ng/L;(81.39±8.62),(70.32±5.97)ng/L;(82.47±5.04),(65.27±5.14)ng/L,(t=2.11～5.17,P＜0.05～0.01)].结论脑血栓急性期患者血浆内皮素水平24 h内有早晨高和晚上低的节律性变化,其变化与脑血栓发病早晨为高发时间的现象一致.

Rhythm of plasma endothelins in patients with acute stroke within 24 hours

BACKGROUND: High incidence rate in the morning and low incidence rate in the evening is the regularity of stroke; however, there are no clear reports on changes of concentration of plasma endothelins and its relationship with onset of cerebral thrombus.OBJECTIVE: To investigate dynamic regularity of plasma endothelins in patients with acute cerebral thrombus within 24 hours and its correlation with episode.DESIGN: Case-controlled study.SETTING: Center of Radio-immunology and Department of Laboratory of Affiliated Hospital of Medical College of Qingdao University.PARTICIPANTS: Totally 32 patients with cerebral thrombus were selected from Neurological Department of Affiliated Hospital of Medical College of Qingdao University from January 2002 to January 2003. There were 20males and 12 females with mean age of (61.5±4.1) years. Ten patients had history of diabetes mellitus combined with hypertension, 8 had history of hypertension, 1 had history of diabetes mellitus, and 13 did not have history of diabetes mellitus and hypertension. Another 30 healthy subjects were selected from the same hospital including 13 males and 17 females with the mean age of (58.1±6.25) years. Informed consent was obtained from all subjects.METHODS: Radio-immune analysis was used to determine the dynamic changes of plasma-endothelins level in 32 patients with cerebral thrombus and 20 healthy subjects at 2, 8, 14 and 20 o'clock.MAIN OUTCOME MEASURES: ① Plasma-endothelins level of patients in cerebral thrombus group and control group at the four time points within 24 hours; ② Plasma-endothelins level of patients with or without cerebral thrombus at the four time points within 24 hours.RESULTS: Totally 32 patients with cerebral thrombus and 30 subjects in control group entered the final analysis. ① Plasma-endothelins level in cerebral thrombus group day and night was higher than that in the control group (t=29.1-30.5, P ＜ 0.001). The level was the lowest (69.96±3.92) ng/L] at 2 o'clock within 24 hours but the highest at 8 o'clock (78.55±3.80) ng/L,(t=5.67, P ＜ 0.01)]. ② Levels of endothelins in patients with history of hypertension and cerebral thrombus were obviously higher than those in patients without history of hypertension and cerebral thrombus at 2, 8, 14 and 20 o 'clock within 24 hours (73.28±7.89), (64.52±5.29) ng/L; (82.39±8.62),(75.81±5.14) ng/L; (81.39±8.62), (70.32±5.97) ng/L; (82.47±5.04),(65.27±5.14) ng/L, (t=2.11-5.17, P ＜ 0.05-0.01)].CONCLUSION: Plasma-endothelins level in patients with acute cerebral thrombus has rhythm changes within 24 hours. The changes are high in the morning and low in the evening, and this is accorded with high onset of cerebral thrombus in the morning.