Sokół Bartosz, Urbaniak Bartosz, Wąsik Norbert, Plewa Szymon, Klupczyńska Agnieszka, Jankowski Roman, Więckowska Barbara, Juszkat Robert, Kokot Zenon
Department of Neurosurgery, Poznan University of Medical Sciences, Poznan, Poland.
Faculty of Pharmacy, Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, Poznan, Poland.
Front Neurol. 2017 Aug 28;8:438. doi: 10.3389/fneur.2017.00438. eCollection 2017.
The authors are aware of only one article investigating amino acid concentrations in cerebrospinal fluid (CSF) in patients with ruptured intracranial aneurysms, and this was published 31 years ago. Since then, both management of subarachnoid haemorrhage (SAH) and amino acid assay techniques have seen radical alterations, yet the pathophysiology of SAH remains unclear.
To analyse the pattern of concentrations of amino acids and related compounds in patients with different outcomes following aneurysmal SAH.
49 CSF samples were collected from 23 patients on days 0-3, 5, and 10 post-SAH. Concentrations of 33 amino acids and related compounds were assayed by liquid chromatography tandem mass spectrometry in patients with good [Glasgow Outcome Scale (GOS) 1-3] and poor (GOS 4-5) outcome.
Of the 33 compounds assayed, only hydroxyproline and 3-aminoisobutyric acid appeared not to increase significantly following SAH. In poor outcome patients, we found significantly higher concentrations of aspartic acid ( = 0.038), glutamic acid ( = 0.038), and seven other compounds on days 0-3 post-SAH; glutamic acid ( = 0.041) on day 5 post-SAH, and 2-aminoadipic acid ( = 0.033) on day 10 post-SAH. The most significant correlation with GOS at 3 months was found for aminoadipic acid on day 10 post-SAH (cc = -0.81).
Aneurysmal rupture leads to a generalised increase of amino acids and related compounds in CSF. The patterns differ between good and poor outcome cases. Increased excitatory amino acids are strongly indicative of poor outcome.
作者仅知晓一篇关于颅内动脉瘤破裂患者脑脊液（CSF）中氨基酸浓度的研究文章，且该文章发表于31年前。自那时起，蛛网膜下腔出血（SAH）的治疗方法和氨基酸检测技术均发生了根本性变化，但SAH的病理生理学仍不清楚。
分析动脉瘤性SAH后不同预后患者脑脊液中氨基酸及相关化合物的浓度模式。
在SAH后第0 - 3天、第5天和第10天，从23例患者中收集了49份脑脊液样本。采用液相色谱串联质谱法测定了预后良好（格拉斯哥预后评分[GOS] 1 - 3）和预后不良（GOS 4 - 5）患者脑脊液中33种氨基酸及相关化合物的浓度。
在所检测的33种化合物中，只有羟脯氨酸和3 - 氨基异丁酸在SAH后似乎没有显著增加。在预后不良的患者中，我们发现SAH后第0 - 3天，天冬氨酸（P = 0.038）、谷氨酸（P = 0.038）和其他7种化合物的浓度显著升高；SAH后第5天谷氨酸（P = 0.041）浓度升高，SAH后第10天2 - 氨基己二酸（P = 0.033）浓度升高。SAH后第10天的氨基己二酸与3个月时的GOS相关性最为显著（cc = -0.81）。
动脉瘤破裂导致脑脊液中氨基酸及相关化合物普遍升高。预后良好和预后不良的病例模式不同。兴奋性氨基酸升高强烈提示预后不良。
