Ang Beng Ti, Tan Wan Loo, Lim Joyce, Ng Ivan
The Acute Brain Injury Research Laboratory, Section of Neurotrauma, Department of Neurosurgery, (Tan Tock Seng Hospital Campus), National Neuroscience Institute, Singapore.
J Clin Neurosci. 2005 Sep;12(7):758-62. doi: 10.1016/j.jocn.2004.09.021.
The hypothalamus, a vital regulator of multiple physiologic functions, is the principal source of the neuropeptide orexin, which is thought to regulate the sleep-wake cycle. As hypothalamic damage may result from aneurysmal subarachnoid haemorrhage (SAH) and be associated with a depressed conscious level, we sought to investigate whether orexin levels reflected the severity of the ictus and were of any prognostic value in SAH. CSF orexin levels from 15 patients with aneurysmal SAH were analysed for up to 14 days. The correlation between orexin and GCS, WFNS grade, Fisher grade, GOS at 6 months and hydrocephalus were ascertained. Orexin levels in 5 patients with normal pressure hydrocephalus were used as controls. Patients with GCS less than 8 on admission had undetectable orexin whilst those with a GCS of 8 or greater had measurable orexin (p < 0.05). CSF orexin levels appear to correlate with conscious level and might be a valid indicator of hypothalamic injury. As some adverse sequelae of SAH are due to hypothalamic damage, pharmacological manipulation of orexinergic neuronal pathways could lead to exciting therapeutic options in the future.
下丘脑是多种生理功能的重要调节者，是神经肽食欲素的主要来源，据认为该神经肽可调节睡眠-觉醒周期。由于动脉瘤性蛛网膜下腔出血（SAH）可能导致下丘脑损伤，并与意识水平降低相关，我们试图研究食欲素水平是否反映了发作的严重程度以及在SAH中是否具有任何预后价值。对15例动脉瘤性SAH患者的脑脊液食欲素水平进行了长达14天的分析。确定了食欲素与格拉斯哥昏迷量表（GCS）、世界神经外科医师联盟（WFNS）分级、费希尔分级、6个月时的格拉斯哥预后评分（GOS）以及脑积水之间的相关性。将5例正常压力脑积水患者的食欲素水平用作对照。入院时GCS小于8分的患者食欲素检测不到，而GCS为8分或更高的患者食欲素可测（p<0.05）。脑脊液食欲素水平似乎与意识水平相关，可能是下丘脑损伤的有效指标。由于SAH的一些不良后遗症是由下丘脑损伤引起的，对食欲素能神经元通路进行药物干预可能在未来带来令人兴奋的治疗选择。
