Sakai N, Nakayama K, Tanabe Y, Izumiya Y, Nishizawa S, Uemuara K
Department of Neurosurgery, Shimizu Kosei Hospital, Japan.
Neurosurgery. 1999 Jul;45(1):34-8; discussion 38-9. doi: 10.1097/00006123-199907000-00010.
We examined the hypothesis that a plasma protease-antiprotease imbalance contributes to the formation of saccular cerebral aneurysms and the suggestion that the assay of these enzymes might be a screening tool for people at higher risk for aneurysm formation.
From June 1997 through May 1998, the plasma leukocyte elastase, which is an important proteolytic enzyme, and alpha-antitrypsin and alpha2-macroglobulin, which are important antiproteolytic enzyme plasma proteins, were examined in 18 patients with ruptured aneurysms, 9 patients with unruptured aneurysms, and 22 controls.
The elastase:alpha1-antitrypsin ratio and the elastase:alpha2-macroglobulin ratios were significantly higher in patients with ruptured aneurysms within 24 hours after subarachnoid hemorrhage (SAH) than in the controls. The protease-antiprotease imbalance depended on the elevation of the elastase level, which might be correlated with leukocytosis after SAH. The elastase level decreased to the control level 3 months after the onset of SAH. No significant difference in the elastase:alpha1-antitrypsin and elastase:alpha2-macroglobulin ratios was observed between the patients with unruptured aneurysms and the controls.
These results do not support the hypothesis that a plasma protease-antiprotease imbalance is a potential marker to predict the formation of saccular cerebral aneurysms. The increase in plasma elastase levels in patients with ruptured aneurysms might be attributable to leukocytosis after SAH.
我们检验了血浆蛋白酶 - 抗蛋白酶失衡导致囊状脑动脉瘤形成的假说，以及检测这些酶可能成为动脉瘤形成高危人群筛查工具的建议。
从1997年6月至1998年5月，对18例破裂动脉瘤患者、9例未破裂动脉瘤患者和22名对照者检测了血浆白细胞弹性蛋白酶（一种重要的蛋白水解酶）以及α - 抗胰蛋白酶和α2 - 巨球蛋白（两种重要的抗蛋白水解酶血浆蛋白）。
蛛网膜下腔出血（SAH）后24小时内，破裂动脉瘤患者的弹性蛋白酶:α1 - 抗胰蛋白酶比值和弹性蛋白酶:α2 - 巨球蛋白比值显著高于对照组。蛋白酶 - 抗蛋白酶失衡取决于弹性蛋白酶水平的升高，这可能与SAH后的白细胞增多有关。SAH发病3个月后，弹性蛋白酶水平降至对照水平。未破裂动脉瘤患者与对照组之间的弹性蛋白酶:α1 - 抗胰蛋白酶和弹性蛋白酶:α2 - 巨球蛋白比值未观察到显著差异。
这些结果不支持血浆蛋白酶 - 抗蛋白酶失衡是预测囊状脑动脉瘤形成的潜在标志物这一假说。破裂动脉瘤患者血浆弹性蛋白酶水平升高可能归因于SAH后的白细胞增多。
