Dohi K, Ripley B, Fujiki N, Ohtaki H, Shioda S, Aruga T, Nishino S
Showa University, Department of Emergency and Critical Care Medicine, School of Medicine, 1-5-8 Hatanodai, Tokyo, Japan.
Peptides. 2005 Nov;26(11):2339-43. doi: 10.1016/j.peptides.2005.04.004.
The aim of this study was to examine the role of the hypothalamic hypocretin/orexin system in complications of delayed ischemic neuronal deficit (DIND) resulting from symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage (SAH). CSF hypocretin-1/orexin-A levels were measured in 15 SAH patients. DIND complications occurred in seven patients with symptomatic vasospasm. Hypocretin-1/orexin-A levels were low in SAH patients during the 10 days following the SAH event. CSF hypocretin-1/orexin-A levels were lower in patients with DIND complications than in those who did not develop DIND. A significant transient decline in CSF hypocretin-1/orexin-A levels was also observed at the onset of DIND in all patients with symptomatic vasospasm. The reduced hypocretin/orexin production observed in SAH patients may reflect reduced brain function due to the decrease in cerebral blood flow. These results, taken together with recent experimental findings in rats that indicate hypocretin receptor 1 (orexin 1 receptor) mRNA and protein are elevated following middle cerebral artery occlusion, suggest that a reduction in hypocretin/orexin production in SAH and DIND patients is associated with alterations in brain hypocretin/orexin signaling in response to ischemia.
本研究的目的是探讨下丘脑泌素/食欲素系统在动脉瘤性蛛网膜下腔出血（SAH）患者因症状性血管痉挛导致的迟发性缺血性神经功能缺损（DIND）并发症中的作用。对15例SAH患者的脑脊液中泌素-1/食欲素-A水平进行了测定。7例出现症状性血管痉挛的患者发生了DIND并发症。SAH事件后的10天内，SAH患者的泌素-1/食欲素-A水平较低。发生DIND并发症的患者脑脊液中泌素-1/食欲素-A水平低于未发生DIND的患者。在所有出现症状性血管痉挛的患者中，DIND发作时脑脊液中泌素-1/食欲素-A水平也出现了显著的短暂下降。SAH患者中观察到的泌素/食欲素产生减少可能反映了由于脑血流量减少导致的脑功能下降。这些结果与最近在大鼠中的实验结果一起表明，大脑中动脉闭塞后，泌素受体1（食欲素1受体）的mRNA和蛋白水平升高，提示SAH和DIND患者中泌素/食欲素产生的减少与缺血反应时脑泌素/食欲素信号传导的改变有关。
