蛛网膜下腔出血后血浆和脑脊液ET、CGRP变化与脑血管痉挛的关系

目的：观察伴和不伴脑血管痉挛蛛网膜下腔出血患者血浆与脑脊液中ET和CGRP浓度的变化。方法：根据是否合并脑血管痉挛，将53例蛛网膜下腔出血患者分为有症状脑血管痉挛组、无症状脑血管痉挛组和非痉挛组。72h、1W、2W、3W和4W时分别抽血和采取脑脊液，对照组为无神经系统疾病、免疫系统疾病与免疫相关疾病的外科手术病人，分别测定血浆和脑脊液中ET和CGRP含量。结果：出血后。3组患者血浆和脑脊液ET逐渐增加，1-2W时达最高，随后含量又逐步降低，而血浆和脑脊液CGRP逐渐降低，1-2W时降到最低，随后含量又逐步升高：1W、2W、3W时痉挛组血浆和脑脊液中CGRP含量较非痉挛组明显降低，而ET含量较非痉挛组明显增高。结论：蛛网膜下腔出血后血浆和脑脊液ET升高与CGRP含量降低可能是引起脑血管痉挛的重要因素。

Relation between cerebral vasospasm and changes of ET and CGRP in plasma and CSF after subarachnoid hemorrhage

Objective:To study changes of ET and CGRP in plasma and CSF of SAH patients with and without delayed cerebral vasospasm. Methods:53 cases of SAH were divided into symptomatic cerebral vasospasm group,asymptomatic cerebral vasospasm group and nonvasospasm group. Plasma and CSF specimen were obtained at 72h,1w,2w,3w and 4w after subarachnoid hemorrhage,and levels of ET and CGRP in plasma and CSF were detected.Results: After onset of SAH,levels of ET in plasma and CSF of all cases began to increase,and reached the peaks within 1-2w,then decreased gradually;Levels of CGRP in plasma and CSF began to increase after SAH,and reached the bottom within 1-2w then increased gradually;Levels of ET in plasma and CSF of cases in vasospasm groups were higer than those of nonvasospasm groups,and levels of CGRP in plasma and CSF of cases in vasospasm groups were lower than those of nonvasospasm groups.There were significant difference.Conclusions: Lower levels of ET and CGRP in plasma and CSF maybe the critical factors for cerebral vasospasm after SAH.