血管性假血友病因子与ADAMTS13在动脉瘤性蛛网膜下腔出血患者中的动态变化及意义(1)
【摘要】目的 了解血管性假血友病因子(vWF)与ADAMTS13在动脉瘤性蛛网膜下腔出血患者(aneurysmal subarachnoid hemorrhage，aSAH)中的动态变化及意义。方法 采用回顾性分析方法，将苏州大学附属第一医院神经外科2010年4月至2011年4月收治的动脉瘤性蛛网膜下腔出血患者29例，分成迟发性脑缺血组(DCI组)和非迟发性脑缺血组(无DCI组)、脑血管痉挛组(CVS组)和无痉挛组(无CVS组)、预后良好组和预后不良组，并引入正常健康体检者20例作为对照组。所有入选患者均行CT、DSA和(或)CTA确诊为颅内动脉瘤破裂致蛛网膜下腔出血。排除标准：(1)入院时发病已超过72 h或即将死亡患者；(2)在外院已接受手术、介入或内科保守治疗患者；(3)正在使用抗血小板药物如阿司匹林、氯吡格雷，或其他抗凝药物如华法林等；(4)有血液系统疾病、肝肾功能不全、近期有感染性疾病、孕期患者。分别在SAH后第1天、第4天、第10天收集静脉血，使用ELISA方法检测vWF抗原和ADAMTS13活性，观察其动态变化，TCD检测大脑中动脉的血流速度(VMCA)，出院时行GOS预后评分。使用SPSS 13.0统计软件进行统计学处理，计量资料以均数±标准差( x±s )表示，并行 t 检验，多组比较采用方差分析。以 P <0.05为差异有统计学意义。结果 血浆vWF水平在DCI组、CVS组及预后不良组第1天、第4天、第10天3个时间点均高于健康对照组，DCI组与无DCI组相比在第1天、第4天时间点组间比较差异具有统计学意义(P <0.05)，在第4天、第10天，CVS组与无CVS组，预后良好组与预后不良组组间比较差异具有统计学意义(P <0.01)。DCI组与预后不良组在T1时间点血浆ADAMTS13活性显著下降；而在是否发生CVS患者之间血浆ADAMTS13活性差异无统计学意义。结论 早期血浆vWF水平升高、ADAMTS13活性下降与DCI发生有关，并且早期ADAMTS13活性下降与预后相关。
【关键词】蛛网膜下腔出血；动脉瘤性蛛网膜下腔出血；vWF；ADAMTS13；迟发性脑缺血；脑血管痉挛；预后
The expression of von Willebrand factor and ADAMTS13 in aneurysmal subarachnoid hemorrhage QIAN Jin—xian*， LI Lei， LU Shi—qi， CHEN Gang，ZHAO Yi—ming. *Department of ICU， Suzhou Municipal Hospital (North Campus)， Nanjin Medical University， Suzhou 215008， China
Corresponding author： LU Shi—qi ， Email： lushiqi2004@126.com
【Abstract】Objective To study the clinical values of dynamic changes of von Willebrand factor (vWF) and ADAMTS13 (a disintegrin and metalloprotease with thrombospondin repeats—13) in aneurysmal subarachnoid hemorrhage. Methods Twenty—nine patients with aneurysmal subarachnoid hemorrhage admitted to Department of Neurosurgery from April 2010 through April 2011 were enrolled for retrospective study. They could be categorized into 3 sets of grouping：delayed cerebral ischemia group (DCI group) and non—delayed cerebral ischemia group (no DCI group)，cerebral vasospasm group (CVS group) and no vasospasm group (no CVS group)， and good prognosis group and poor prognosis group， and another 20 healthy subjects as control group. All patients were examined with CT， DSA， or/and CTA to identify the intracranial subarachnoid hemorrhage resulted from aneurysm rupture. The exclusion criteria included： (1) the time from onset to admission was longer than 72 hours or patient was in imminent danger of death； (2) patients had surgery， interventional or conservative treatment outside the hospital； (3) patients were under the treatment of antiplatelet medicine such as aspirin， clopidogrel， or other anticoagulants such as warfarin， etc； (4) patients had blood diseases， impaired kidney or liver function， pregnant， or with recent infections. Venous blood were taken one day， 4 days and 10 days after SAH to determine plasma concentrations of ADAMTS13 and vWF by using enzyme—linked immunosorbent assay (ELISA). Transcranial Doppler ultrasonography (TCD) was used to measure mean blood flow velocity of middle cerebral artery (VMCA). Glasgow outcome scale (GOS) score was measured before discharge. Data were analyzed by using SPSS version 13.0 software.Results The levels of vWF were significantly higher in DCI group， CVS group and poor prognosis group compared with those in the control group 1 day， 4 days and 10 days after SAH. There were differences in vWF between DCI group and no DCI group 1 day and 4 days after SAH ( P <0.05). There were significantly differences in vWF between CVS group and no CVS group， and between good prognosis group and poor prognosis group 4 days and 10 days after SAH ( P <0.01). In DCI group and poor prognosis group， the level of plasma ADAMTS13 was significantly lower 1 day after SAH than that in the normal control group (P <0.01) and in the no DCI group (P <0.01)； and there were no differences in ADAMTS13 between CVS group and no CVS group. Conclusions In the early stage， the increase in plasma vWF and decrease in ADAMTS13 activity are associated with DCI， and the decrease in ADAMTS13 activity can be used to predict the outcome.
, http://www.100md.com(钱进先 李磊 陆士奇 陈罡 赵益明)
【关键词】蛛网膜下腔出血；动脉瘤性蛛网膜下腔出血；vWF；ADAMTS13；迟发性脑缺血；脑血管痉挛；预后
The expression of von Willebrand factor and ADAMTS13 in aneurysmal subarachnoid hemorrhage QIAN Jin—xian*， LI Lei， LU Shi—qi， CHEN Gang，ZHAO Yi—ming. *Department of ICU， Suzhou Municipal Hospital (North Campus)， Nanjin Medical University， Suzhou 215008， China
Corresponding author： LU Shi—qi ， Email： lushiqi2004@126.com
【Abstract】Objective To study the clinical values of dynamic changes of von Willebrand factor (vWF) and ADAMTS13 (a disintegrin and metalloprotease with thrombospondin repeats—13) in aneurysmal subarachnoid hemorrhage. Methods Twenty—nine patients with aneurysmal subarachnoid hemorrhage admitted to Department of Neurosurgery from April 2010 through April 2011 were enrolled for retrospective study. They could be categorized into 3 sets of grouping：delayed cerebral ischemia group (DCI group) and non—delayed cerebral ischemia group (no DCI group)，cerebral vasospasm group (CVS group) and no vasospasm group (no CVS group)， and good prognosis group and poor prognosis group， and another 20 healthy subjects as control group. All patients were examined with CT， DSA， or/and CTA to identify the intracranial subarachnoid hemorrhage resulted from aneurysm rupture. The exclusion criteria included： (1) the time from onset to admission was longer than 72 hours or patient was in imminent danger of death； (2) patients had surgery， interventional or conservative treatment outside the hospital； (3) patients were under the treatment of antiplatelet medicine such as aspirin， clopidogrel， or other anticoagulants such as warfarin， etc； (4) patients had blood diseases， impaired kidney or liver function， pregnant， or with recent infections. Venous blood were taken one day， 4 days and 10 days after SAH to determine plasma concentrations of ADAMTS13 and vWF by using enzyme—linked immunosorbent assay (ELISA). Transcranial Doppler ultrasonography (TCD) was used to measure mean blood flow velocity of middle cerebral artery (VMCA). Glasgow outcome scale (GOS) score was measured before discharge. Data were analyzed by using SPSS version 13.0 software.Results The levels of vWF were significantly higher in DCI group， CVS group and poor prognosis group compared with those in the control group 1 day， 4 days and 10 days after SAH. There were differences in vWF between DCI group and no DCI group 1 day and 4 days after SAH ( P <0.05). There were significantly differences in vWF between CVS group and no CVS group， and between good prognosis group and poor prognosis group 4 days and 10 days after SAH ( P <0.01). In DCI group and poor prognosis group， the level of plasma ADAMTS13 was significantly lower 1 day after SAH than that in the normal control group (P <0.01) and in the no DCI group (P <0.01)； and there were no differences in ADAMTS13 between CVS group and no CVS group. Conclusions In the early stage， the increase in plasma vWF and decrease in ADAMTS13 activity are associated with DCI， and the decrease in ADAMTS13 activity can be used to predict the outcome.
, http://www.100md.com(钱进先 李磊 陆士奇 陈罡 赵益明)