Vermeulen M, van Vliet H H, Lindsay K W, Hijdra A, van Gijn J
J Neurosurg. 1985 Oct;63(4):573-7. doi: 10.3171/jns.1985.63.4.0573.
In 48 patients with a subarachnoid hemorrhage, levels of fibrin/fibrinogen degradation products (FDP's), total protein, and plasminogen were measured in the cerebrospinal fluid (CSF) between Days 9 and 15 after the bleed. Of these 48 patients, 22 received tranexamic acid. Despite a significant reduction in the incidence of rebleeding in patients taking tranexamic acid, no difference in FDP levels was found between patients receiving tranexamic acid and a control group of patients who were not; nor was any relationship evident between FDP levels and rebleeding. In patients with detectable levels of FDP's, CSF protein and plasminogen values were also increased, and FDP's were found more frequently in the CSF of patients with an impaired level of consciousness or with a neurological deficit. These findings suggest that in the 2nd week after subarachnoid hemorrhage, the presence of FDP's in the CSF reflects a damaged blood-CSF barrier rather than ongoing local fibrinolysis in the subarachnoid space. A finding of FDP's in the CSF is, therefore, an unreliable monitor of antifibrinolytic treatment in subarachnoid hemorrhage and cannot be used for selecting patients at high risk of rebleeding.
对48例蛛网膜下腔出血患者，在出血后第9天至第15天期间测定其脑脊液（CSF）中的纤维蛋白/纤维蛋白原降解产物（FDP）、总蛋白和纤溶酶原水平。这48例患者中，22例接受了氨甲环酸治疗。尽管服用氨甲环酸的患者再出血发生率显著降低，但接受氨甲环酸治疗的患者与未接受治疗的对照组患者之间FDP水平并无差异；FDP水平与再出血之间也未发现明显关联。在FDP可检测到的患者中，CSF蛋白和纤溶酶原值也升高，且意识水平受损或有神经功能缺损的患者CSF中FDP更常见。这些发现表明，蛛网膜下腔出血后第2周，CSF中FDP的存在反映了血-脑脊液屏障受损，而非蛛网膜下腔内正在进行的局部纤维蛋白溶解。因此，CSF中FDP的检测结果是蛛网膜下腔出血抗纤溶治疗的不可靠监测指标，不能用于筛选再出血高危患者。
