Paolo G, Paola G, y Baena Riccardo R, Catherine K, Vittorio G, Fulvio T, Barbara B, Flavio T, Nicoletta F, Fulvio M
Department of Neurosurgery, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
J Neurol Sci. 1997 Nov 25;152(2):154-9. doi: 10.1016/s0022-510x(97)00157-3.
Recent studies have suggested that a quantitative or a qualitative imbalance between the activity of proteases and its inhibitors hypothetically might be involved in intracranial aneurysm rupture. In the present study we test the hypothesis that the systemic reduction of alpha1-antitrypsin activity might be related to the elevated oxidative potential exerted by cigarette smoking and/or to a systemic low antioxidant capacity. We studied, in a series of 57 patients bearing intracranial aneurysms, the relationship between alpha1-antitrypsin activity, cigarette smoking and the following variables measured in plasma: vitamin A, vitamin E, thiol groups, urate and lipid peroxide levels. Serum levels of alpha1-antitrypsin are higher in patients with subarachnoid hemorrhage than in cases of unruptured aneurysms, while the levels of vitamin A and vitamin E are significantly lower in patients that suffered subarachnoid hemorrhage than in controls. Both vitamin A and E levels are related to the occurrence of rupture of the aneurysm, as elicited by logistic regression analysis (P=0.017 and P=0.014, respectively), with a protective effect of higher levels of the variables, as shown by their odds ratio (0.028 and 0.84, respectively). No significant changes in the strength of the association could be appreciated when controlling for smoking habit. None of the other tested variables could be related to the occurrence of the aneurysm rupture. Both alpha1-antitrypsin serum level and the level of vitamin A appeared to be independently related to alpha1-antitrypsin collagenase inhibitory capacity percentage (P=0.03 and P=0.025), with no independent influence of the type of aneurysm and the smoking habit. The results of the present study show that the qualitative pattern of alpha1-antitrypsin is significantly related to the serum level of liposoluble vitamin A, while the type of aneurysm and the smoking habit have no independent influence. This suggests that in a situation in which systemic levels of vitamin A are reduced, the risk of a reduced activity of alpha1-antitrypsin as controller of proteases is elevated, with the consequent increased risk of aneurysm bleeding.
近期研究表明，蛋白酶与其抑制剂活性之间的定量或定性失衡可能与颅内动脉瘤破裂有关。在本研究中，我们检验了以下假设：α1-抗胰蛋白酶活性的全身性降低可能与吸烟所产生的氧化应激增加和/或全身性抗氧化能力低下有关。我们对57例颅内动脉瘤患者进行了研究，分析α1-抗胰蛋白酶活性、吸烟与血浆中以下指标之间的关系：维生素A、维生素E、巯基、尿酸盐和脂质过氧化物水平。蛛网膜下腔出血患者的血清α1-抗胰蛋白酶水平高于未破裂动脉瘤患者，而蛛网膜下腔出血患者的维生素A和维生素E水平显著低于对照组。通过逻辑回归分析发现，维生素A和维生素E水平均与动脉瘤破裂的发生有关（P值分别为0.017和0.014），较高水平的这两个变量具有保护作用，其比值比分别为0.028和0.84。在控制吸烟习惯后，关联强度无显著变化。其他检测变量均与动脉瘤破裂的发生无关。血清α1-抗胰蛋白酶水平和维生素A水平似乎均与α1-抗胰蛋白酶胶原酶抑制能力百分比独立相关（P值分别为0.03和0.025），动脉瘤类型和吸烟习惯无独立影响。本研究结果表明，α1-抗胰蛋白酶的定性模式与脂溶性维生素A的血清水平显著相关，而动脉瘤类型和吸烟习惯无独立影响。这表明，在全身性维生素A水平降低的情况下，作为蛋白酶控制剂的α1-抗胰蛋白酶活性降低的风险增加，从而导致动脉瘤出血风险增加。
