Chiang M-F, Chiu W-T, Lin F J, Thajeb P, Huang C-J, Tsai S-H
Department of Neurosurgery, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
Acta Neurochir (Wien). 2006 Jun;148(6):615-21; dicussion 621. doi: 10.1007/s00701-006-0771-z. Epub 2006 Apr 18.
There is no information regarding the possible role of cerebral substrates in the pathogenesis of neuronal injury in intracerebral haemorrhages (ICHs). Purposes of this prospective study were to clarify whether changes in substrates are the consequence of the initial brain damage in ICH and to elucidate the relationship among the biochemical mechanisms and clinical course of patients with ICH.
During a period of two years, patients (GCS < or =8) who had ICH secondary to an aneurysm (SAH), stroke (sICH), or trauma (tICH) and underwent ventriculostomy with ICP monitoring and/or underwent cranial surgery were randomly enrolled in this study. Extracellular concentrations of glutamate, aspartate, glycine, GABA, lactate, lactate/pyruvate ratio, and glucose in the CSF were measured by use of high-performance liquid chromatography (HPLC). The nitric oxide (NO) concentration in the CSF was analyzed by chemiluminescence.
There were 75 patients (38 women and 37 men) with ICH included in this study. Twenty-one patients had SAH, 28 sICH, and 26 tICH. In tICH patients, there was a 30-fold increase in glutamate and a 10-fold in aspartate over reference values. The levels of glutamate, aspirate, GABA, lactate, glucose, and NO differed significantly among the three groups (p<0.001). There were no significant differences in glycine and L/P ratio among the groups. The initial GCS, the mean CPP and outcome six months after the insult were all significantly correlated with the concentration of substrates (p<0.01), both within groups and among the total sample. The CSF levels of glutamate lactate, NO and glucose correlated significantly with outcome (p<0.005).
This study confirms the correlation between the level of EAAs and the outcome of ICHs, suggesting that neurochemical monitoring of these substances may have a role in caring for patients.
关于脑内基质在脑出血（ICH）神经元损伤发病机制中的可能作用尚无相关信息。本前瞻性研究的目的是阐明基质变化是否为ICH初始脑损伤的结果，并阐明ICH患者生化机制与临床病程之间的关系。
在两年期间，将继发于动脉瘤（SAH）、中风（sICH）或创伤（tICH）且接受脑室造瘘术并进行颅内压监测和/或接受开颅手术的ICH患者（格拉斯哥昏迷评分[GCS]≤8）随机纳入本研究。采用高效液相色谱法（HPLC）测量脑脊液中谷氨酸、天冬氨酸、甘氨酸、γ-氨基丁酸（GABA）、乳酸、乳酸/丙酮酸比值和葡萄糖的细胞外浓度。通过化学发光法分析脑脊液中的一氧化氮（NO）浓度。
本研究纳入了75例ICH患者（38例女性和37例男性）。21例患者为SAH，28例为sICH，26例为tICH。在tICH患者中，谷氨酸水平比参考值增加了30倍，天冬氨酸增加了10倍。三组之间谷氨酸、天冬氨酸、GABA、乳酸葡萄糖和NO的水平差异有统计学意义（p<0.001）。各组之间甘氨酸和L/P比值无显著差异。初始GCS、平均脑灌注压（CPP）和损伤后6个月的预后在组内和总样本中均与基质浓度显著相关（p<0.01）。脑脊液中谷氨酸、乳酸、NO和葡萄糖水平与预后显著相关（p<0.005）。
本研究证实了兴奋性氨基酸（EAA）水平与ICH预后之间的相关性。提示对这些物质进行神经化学监测可能对患者护理有作用。
