Secades J J, Rubio E, Castellanos J M, de la Rosa M D, Mercadal J, Vilalta J, Catalán R, Galard R M
Departamento de Neurocirugía, Hospitals de la Vall d'Hebron, Universidad Autónoma de Barcelona, España.
Rev Neurol. 2000;30(1):27-34.
Cerebral vasospasm is involved in the development of delayed ischemic lesions in patients with subarachnoid hemorrhage. We developed an integral theoretical model to explain the pathophysiology of cerebral vasospasm, in which endothelin-1 has a pivotal role in the development of both cerebral vasospasm and delayed ischemic neurological deficits (DIND).
The objective of this study is to analyze the relationship between temporal profile of plasma endothelin-1 levels and the development of cerebral vasospasm and DIND.
We analyzed sequentially plasma endothelin-1 levels in 17 patients with aneurysmatic subarachnoid hemorrhage. All the patients had complete clinical and neuroradiological studies. Patients were classified according to Fisher's score.
Patients (4 males and 13 females, aged 48.1 +/- 20.3 years) had a good clinical condition (Hunt-Hess < 4, GCS > 10). Two weeks after bleeding, patients had higher plasma endothelin-1 levels than healthy volunteers (p = 0.024). Patients who developed DIND had higher plasma endothelin-1 levels (p = 0.034) and a different evolution (p = 0.0146) than patients without DIND. There is a significant correlation (p = 0.02) between basal plasma endothelin-1 levels and GOS score. Multiple regression analysis shows a significant dependence between plasma endothelin-1 levels and Fisher's score (p = 0.0195), development of DIND (p = 0.0095), and GOS score (p = 0.0319). Logistic regression analysis finds a predictive relation between Fisher's score and plasma endothelin-1 levels for the development of DIND (overall predicted = 74.24%; p = 0.0148).
Plasma endothelin-1 levels are increased in patients after subarachnoid hemorrhage and are associated with the development of cerebral vasospasm and DIND.
蛛网膜下腔出血患者的迟发性缺血性病变发展过程中涉及脑血管痉挛。我们建立了一个完整的理论模型来解释脑血管痉挛的病理生理学，其中内皮素 -1 在脑血管痉挛和迟发性缺血性神经功能缺损（DIND）的发展中起关键作用。
本研究的目的是分析血浆内皮素 -1 水平的时间变化曲线与脑血管痉挛和 DIND 发展之间的关系。
我们对 17 例动脉瘤性蛛网膜下腔出血患者的血浆内皮素 -1 水平进行了连续分析。所有患者均进行了完整的临床和神经放射学检查。患者根据 Fisher 评分进行分类。
患者（4 名男性和 13 名女性，年龄 48.1±20.3 岁）临床状况良好（Hunt-Hess＜4，GCS＞10）。出血两周后，患者的血浆内皮素 -1 水平高于健康志愿者（p = 0.024）。发生 DIND 的患者血浆内皮素 -1 水平更高（p = 0.034），且与未发生 DIND 的患者有不同的变化趋势（p = 0.0146）。基础血浆内皮素 -1 水平与格拉斯哥预后评分（GOS）之间存在显著相关性（p = 0.02）。多元回归分析显示血浆内皮素 -1 水平与 Fisher 评分（p = 0.0195）、DIND 的发生（p = 0.0095）和 GOS 评分（p = 0.0319）之间存在显著相关性。逻辑回归分析发现 Fisher 评分与血浆内皮素 -1 水平之间对于 DIND 的发生存在预测关系（总体预测率 = 74.24%；p = 0.0148）。
蛛网膜下腔出血患者血浆内皮素 -1 水平升高，且与脑血管痉挛和 DIND 的发展相关。
