Nissen J J, Mantle D, Gregson B, Mendelow A D
Department of Surgery (Neurosurgery), Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK.
J Neurol Neurosurg Psychiatry. 2001 Sep;71(3):329-33. doi: 10.1136/jnnp.71.3.329.
Adhesion molecules are involved in the pathogenesis of cerebral ischaemia and may play a part in the pathophysiology of delayed ischaemic neurological deficit (DIND) after aneurysmal subarachnoid haemorrhage. It was hypothesised that after aneurysmal subarachnoid haemorrhage, adhesion molecules may play a part in the pathophysiology of DIND as reflected by significantly altered serum concentrations in patients with and without DIND.
In a prospective study, mean serum concentrations of ICAM-1, VCAM-1, PECAM, and E, P, and L-selectin were compared between patients without (n=23) and with (n=13) DIND in patients with World Federation of Neurological Surgeons (WFNS) grades 1 or 2 subarachnoid haemorrhage. Serum was sampled from patients within 2 days of haemorrhage and on alternate days until discharge. Concentrations of adhesion molecules were measured by standard procedures using commercially available enzyme linked immunoabsorbent assays.
There were non-significant differences in serum concentrations of ICAM-1 (290.8 ng/ml v 238.4 ng/ml, p=0.0525), VCAM-1 (553.2 ng/ml v 425.8 ng/ml, p=0.053), and PECAM (22.0 ng/ml v 21.0 ng/ml, p=0.56) between patients without and with DIND respectively. The E-selectin concentration between the two patient groups (44.0 ng/ml v 37.4 ng/ml, p=0.33) was similar. The P-selectin concentration, however, was significantly higher in patients with DIND compared with those patients without DIND (149.5 ng/ml v 112.9 ng/ml, p=0.039). By contrast, serum L-selectin concentrations were significantly lower in patients with DIND (633.8 ng/ml v 897.9 ng/ml, p=0.013).
Of all the adhesion molecules examined in this study, P and L-selectin are involved in the pathophysiology of DIND after aneurysmal subarachnoid haemorrhage.
黏附分子参与脑缺血的发病机制，可能在动脉瘤性蛛网膜下腔出血后迟发性缺血性神经功能缺损（DIND）的病理生理学中发挥作用。据推测，动脉瘤性蛛网膜下腔出血后，黏附分子可能在DIND的病理生理学中发挥作用，这可通过有或无DIND的患者血清浓度显著改变得以体现。
在一项前瞻性研究中，比较了世界神经外科医师联盟（WFNS）1级或2级蛛网膜下腔出血患者中无DIND（n=23）和有DIND（n=13）患者的细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）、血小板内皮细胞黏附分子（PECAM）以及E、P和L-选择素的平均血清浓度。在出血后2天内及之后每隔一天直至出院采集患者的血清。使用市售酶联免疫吸附测定法通过标准程序测量黏附分子的浓度。
无DIND和有DIND患者的ICAM-1血清浓度（290.8 ng/ml对238.4 ng/ml，p=0.0525）、VCAM-1（553.2 ng/ml对425.8 ng/ml，p=0.053）和PECAM（22.0 ng/ml对21.0 ng/ml，p=0.56）分别无显著差异。两组患者的E-选择素浓度（44.0 ng/ml对37.4 ng/ml，p=0.33）相似。然而，有DIND患者的P-选择素浓度显著高于无DIND患者（149.5 ng/ml对112.9 ng/ml，p=0.039）。相比之下，有DIND患者的血清L-选择素浓度显著降低（633.8 ng/ml对897.9 ng/ml，p=0.013）。
在本研究中检测的所有黏附分子中，P-选择素和L-选择素参与动脉瘤性蛛网膜下腔出血后DIND的病理生理学过程。
