Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
BMC Neurosci. 2021 Apr 23;22(1):29. doi: 10.1186/s12868-021-00634-3.
The implication of the steroids estradiol, progesterone and testosterone in cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) has not been comprehensively assessed. In rodents, studies suggested beneficial effects of steroids on cerebral vasospasm after experimental SAH. Studies in humans are warranted, however, a general dilemma of human studies on neuroactive substances is that the brain is not directly accessible and that concentrations in the periphery may not adequately parallel concentrations in the central compartments. In the present study, concentrations of estradiol, progesterone and testosterone in serum and cerebrospinal fluid (CSF) of patients with aSAH were determined. Blood flow velocities in cerebral arteries were measured by transcranial Doppler sonography (TCD). The aim of this study was to evaluate the correlations between the cerebral blood flow velocities and levels of estradiol, progesterone and testosterone in CSF and serum.
Samples of serum and CSF of 42 patients with aSAH were collected concomitantly daily or every other day via the arterial line and the external ventricular drainage for two weeks after the hemorrhage. Blood flow velocities in the cerebral arteries were determined by TCD. Total estradiol, progesterone and testosterone concentrations were measured by electro-chemiluminescence immunoassay. The strength of correlation was assessed by Spearman's rank correlation coefficient. The correlation analysis revealed very weak correlations between cerebral blood flow velocities and concentrations of estradiol, progesterone and testosterone levels in both compartments with correlation coefficients below 0.2.
In humans with aSAH, merely very weak correlations between flow velocities in cerebral arteries and concentrations of estradiol, progesterone and testosterone in serum and CSF were demonstrated. These results suggest a limited influence of the respective steroids on cerebral vascular tone although vasodilatory effects were described in rodent studies. Thus, the implication of steroids in processes of neurological deterioration warrants further clarification.
在蛛网膜下腔出血（aSAH）后，类固醇雌二醇、孕酮和睾酮对脑血管痉挛的影响尚未得到全面评估。在啮齿动物中，研究表明类固醇对实验性蛛网膜下腔出血后脑血管痉挛有有益作用。然而，在人类中进行研究是必要的，但是，关于神经活性物质的人类研究的一个普遍困境是大脑无法直接触及，并且外周浓度可能不能充分与中枢隔室中的浓度平行。在本研究中，测定了 aSAH 患者血清和脑脊液（CSF）中的雌二醇、孕酮和睾酮浓度。通过经颅多普勒超声（TCD）测量脑动脉的血流速度。本研究的目的是评估 CSF 和血清中雌二醇、孕酮和睾酮的血流速度与水平之间的相关性。
共收集了 42 例 aSAH 患者的血清和 CSF 样本，通过动脉线和外部脑室引流在出血后两周内每天或每隔一天采集。通过 TCD 测量脑动脉的血流速度。通过电化学发光免疫分析法测量总雌二醇、孕酮和睾酮浓度。通过 Spearman 等级相关系数评估相关性的强度。相关性分析显示，在两个隔室中，脑血流速度与雌二醇、孕酮和睾酮浓度之间的相关性非常弱，相关系数低于 0.2。
在患有 aSAH 的人类中，仅在脑动脉血流速度与血清和 CSF 中雌二醇、孕酮和睾酮浓度之间显示出非常弱的相关性。这些结果表明，尽管在啮齿动物研究中描述了血管舒张作用，但各类固醇对脑血管张力的影响有限。因此，类固醇在神经功能恶化过程中的作用需要进一步阐明。
