Juvela S, Ohman J, Servo A, Heiskanen O, Kaste M
Department of Neurosurgery, Helsinki University Central Hospital, Finland.
Stroke. 1991 Apr;22(4):451-5. doi: 10.1161/01.str.22.4.451.
We studied adenosine diphosphate-induced platelet aggregation and the associated release of thromboxane B2 in 49 patients with subarachnoid hemorrhage in relation to angiographic vasospasm. Postoperative cerebral angiography was performed less than or equal to 3 (median 1) days after surgery for an aneurysm 5-14 days after subarachnoid hemorrhage. Correspondingly, one sample from each patient was taken within 24 hours either before or after angiography. The occurrence of severe as well as diffuse, moderate, or severe angiographic vasospasm was associated with the presence of delayed cerebral ischemia (p less than 0.05). Patients with diffuse angiographic vasospasm had significantly higher (p less than 0.05) values for thromboxane B2 release than the others, even after adjustment by the clinical grades on admission and before surgery, the timing of surgery, the time from subarachnoid hemorrhage to angiography and blood sampling, and nimodipine therapy. Severe and diffuse angiographic vasospasm were also associated with poor outcome at 1 year (p less than 0.05). Our results suggest that augmented release of platelet thromboxane may be involved in the pathogenesis of vasospasm in large cerebral arteries.
我们研究了49例蛛网膜下腔出血患者中，二磷酸腺苷诱导的血小板聚集及血栓素B2的相关释放情况，并将其与血管造影显示的血管痉挛相关联。在蛛网膜下腔出血后5 - 14天，针对动脉瘤进行手术后，于术后小于或等于3天（中位数为1天）进行术后脑血管造影。相应地，在血管造影之前或之后的24小时内，从每位患者采集一份样本。严重以及弥漫性、中度或重度血管造影血管痉挛的发生与迟发性脑缺血的存在相关（p < 0.05）。即使在根据入院时和手术前的临床分级、手术时间、从蛛网膜下腔出血到血管造影及采血的时间以及尼莫地平治疗进行调整后，弥漫性血管造影血管痉挛患者的血栓素B2释放值仍显著高于其他患者（p < 0.05）。严重和弥漫性血管造影血管痉挛还与1年时的不良预后相关（p < 0.05）。我们的结果表明，血小板血栓素释放增加可能参与了大脑大动脉血管痉挛的发病机制。
