Männer Anika, Thomas Dominique, Wagner Marlies, Konczalla Jürgen, Steinmetz Helmuth, Brunkhorst Robert, Pfeilschifter Waltraud
Frankfurt University Hospital, Department of Neurology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
Pharmazentrum Frankfurt, Frankfurt University Hospital, Department of Clinical Pharmacology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
Neurol Res Pract. 2020 Nov 23;2:49. doi: 10.1186/s42466-020-00093-x. eCollection 2020.
Sphingosin-1-phosphate (S1P) plays a crucial role as a signaling molecule in the immune system and the vasculature. Previous studies suggested a role as a vasoconstrictor of cerebral arteries via the S1P3-Receptor. Cerebral vasospasm (VS) following aneurysmal subarachnoid hemorrhage (SAH) is a major cause of disability and poor neurological outcome. Early detection of vasospasm could facilitate the prevention of cerebral ischemia in SAH patients. The aim of this prospective case-control study was to characterize the dynamics of S1P in the cerebrospinal fluid (CSF) of patients with SAH in relation to hemorrhage volume, the occurrence of VS, and neurological outcome.
S1P levels in CSF of 18 control subjects and 18 SAH patients with placement of an external ventricular drainage (EVD) were determined by high sensitivity mass spectrometry from day 1 through 14 after SAH onset. Hemorrhage volume, development of asymptomatic vasospasm (aVS) and symptomatic vasospasm (sVS), and neurological outcome were correlated to day 1 S1P levels.
The intrathecal S1P levels of SAH patients were higher than those of the control subjects, and correlated with hemorrhage volume. There was no significant difference in S1P levels between patients with aVS and those with sVS. S1P levels significantly correlated with neurological outcome on a sliding modified Rankin scale.
S1P levels were highest directly after placement of the EVD and correlated strongly with hemorrhage volume, which may be caused by the intrathecal clot and subsequent lysis of red blood cells, an important source of S1P. We did not detect a second peak of S1P release over the course of the intensive care period.
鞘氨醇-1-磷酸（S1P）作为一种信号分子，在免疫系统和脉管系统中发挥着关键作用。先前的研究表明，它可通过S1P3受体发挥脑动脉血管收缩剂的作用。动脉瘤性蛛网膜下腔出血（SAH）后的脑血管痉挛（VS）是导致残疾和神经功能预后不良的主要原因。早期检测血管痉挛有助于预防SAH患者的脑缺血。这项前瞻性病例对照研究的目的是，探讨SAH患者脑脊液（CSF）中S1P的动态变化及其与出血量、VS的发生和神经功能预后的关系。
对18名对照受试者和18名接受脑室外引流（EVD）的SAH患者，在SAH发病后第1天至第14天，通过高灵敏度质谱法测定其脑脊液中的S1P水平。将出血量、无症状血管痉挛（aVS）和症状性血管痉挛（sVS）的发生情况以及神经功能预后与第1天的S1P水平进行相关性分析。
SAH患者的鞘内S1P水平高于对照受试者，且与出血量相关。aVS患者和sVS患者的S1P水平无显著差异。S1P水平与改良Rankin量表滑动评分的神经功能预后显著相关。
EVD置入后，S1P水平立即达到最高，并与出血量密切相关，这可能是由鞘内血凝块以及随后红细胞溶解（S1P的重要来源）所致。在重症监护期间，我们未检测到S1P释放的第二个峰值。
