Wijdicks E F, Heublein D M, Burnett J C
Department of Neurology, Saint Marys Hospital, Rochester, Minnesota, USA.
J Neurosurg. 2001 Feb;94(2):252-6. doi: 10.3171/jns.2001.94.2.0252.
Natriuresis is a common systemic manifestation of aneurysmal subarachnoid hemorrhage (SAH). Natriuresis and its accompanying hypovolemia may be a major contributing factor in the pathophysiology of symptomatic cerebral vasospasm.
The authors studied 14 consecutive patients with aneurysmal SAH and compared levels of adrenomedullin (ADM), a novel endogenous natriuretic peptide that possesses additional profound vasodilatory properties, with the natriuretic peptide system by using radioimmunoassay. The mean ADM values on admission were 24.8 pg/ml, a twofold increase over control values, but no correlation was found with atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-natriuretic peptide (CNP) from the natriuretic peptide system. At Day 5 post-SAH, ADM levels were significantly elevated in patients with vasospasm documented angiographically or on transcranial Doppler studies as compared with those who suffered no vasospasm (mean 61.9 pg/ml compared with 15.3 pg/ml, p < 0.01).
The authors conclude that an elevation of ADM in plasma may indicate a physiological regulatory attempt to induce cerebral vasodilation. The regulation of ADM is uncoupled from ANP, BNP, and CNP.
利钠作用是动脉瘤性蛛网膜下腔出血（SAH）常见的全身表现。利钠作用及其伴随的血容量减少可能是症状性脑血管痉挛病理生理学中的一个主要促成因素。
作者研究了14例连续的动脉瘤性SAH患者，并通过放射免疫分析法，将一种具有额外显著血管舒张特性的新型内源性利钠肽——肾上腺髓质素（ADM）的水平与利钠肽系统进行比较。入院时ADM的平均水平为24.8 pg/ml，比对照值增加了两倍，但未发现与利钠肽系统中的心房利钠肽（ANP）、脑利钠肽（BNP）和C型利钠肽（CNP）存在相关性。在SAH后的第5天，经血管造影或经颅多普勒检查证实有血管痉挛的患者，其ADM水平显著高于未发生血管痉挛的患者（平均分别为61.9 pg/ml和15.3 pg/ml，p < 0.01）。
作者得出结论，血浆中ADM水平升高可能表明机体试图通过生理调节诱导脑血管舒张。ADM的调节与ANP、BNP和CNP无关。
