Imanaga H, Osugi T, Kagawa M, Kita-Mura K
No Shinkei Geka. 1977 Jan;5(1):51-8.
This study was aimed to investigate the correlation between recurrent hemorrhage of ruptured intracranial aneurysm and local fibrinolytic activity of aneurysmal fibrin plug. The fibrinolytic activity of cerebrospinal fluid (CSF) was investigated in 63 patients with various neurological diseases by means of modified fibrin plate method. No plasmin was elicited in normal CSF, however, it was confirmed that CSF contained an incomplete activator which became a complete activator inthe presence of streptokinase, and plasminogen was identified in the presence of urokinase. In 26 cases of subarachnoid hemorrhage, the fibrinolytic activity of CSF occurred in the patients within two weeks following hemorrhagic ictus. In almost cases, the fibrinolytic activity of CSF was not increased in the first three weeks after the onset of hemorrhage. This result agreed with the fact that rebleeding of intracranial aneurysm tended to occur within two weeks after the hemorrhage. Therefore, intensive antifibrinolytic therapy for two weeks after onset of hemorrhage is necessary in order to prevent recurrent hemorrhage of intracranial aneurysm, and its doses should be sufficient to inhibit local fibinolysis. It has been suggested that the local fibrinolysis after subarachnoid hemorrhage would be caused by activators released from damaged surrounding brain tissues. Furthermore, it is strongly suggested from the result of our in vitro experiments that coexistence of CSF and blood play an important role to increase local fibrinolysis.
本研究旨在探讨颅内动脉瘤破裂后再出血与动脉瘤纤维蛋白栓局部纤溶活性之间的相关性。采用改良纤维蛋白平板法对63例患有各种神经系统疾病的患者的脑脊液（CSF）纤溶活性进行了研究。正常脑脊液中未检测到纤溶酶，但证实脑脊液中含有一种不完全激活剂，在链激酶存在下可成为完全激活剂，且在尿激酶存在下可鉴定出纤溶酶原。在26例蛛网膜下腔出血患者中，脑脊液纤溶活性在出血发作后两周内出现。在几乎所有病例中，出血后前三周脑脊液纤溶活性并未增加。这一结果与颅内动脉瘤再出血倾向于在出血后两周内发生这一事实相符。因此，为防止颅内动脉瘤再出血，出血发作后两周内进行强化抗纤溶治疗是必要的，且其剂量应足以抑制局部纤溶。有人提出蛛网膜下腔出血后的局部纤溶是由受损周围脑组织释放的激活剂引起的。此外，从我们的体外实验结果强烈表明，脑脊液和血液的共存对增加局部纤溶起着重要作用。
