Research on the transcriptional mechanism of the smooth muscle cell under the vasospasm following subarachnoid hemorrhage

背景技术背景：肾上腺髓质素（AM）是一种血管舒张肽，从脉络丛分泌到脑脊液（CSF）中，并在肾脏中发挥利钠作用。动脉瘤性蛛网膜下腔出血（SAH）发生后7-10天，CSF AM浓度升高。本研究的目的是确定脑脊液AM浓度是否与SAH后低钠血症和迟发性缺血性神经功能缺损（DIND）相关。方法：对32例在发病48小时内接受蛛网膜下腔夹闭术的SAH患者的CSF和血浆AM、脑钠肽和心钠肽浓度进行了测定。在早期（第1-3天，第0天被认为是SAH发作的当天）和晚期（第8-10天）从这些患者获得CSF和血液样品。研究结果：在所有患者中，在早期和晚期期间CSF中的AM浓度显著高于血浆中的AM浓度（p = 0.0028和p < 0.0001）。此外，CSF AM浓度在晚期显著高于早期（p < 0.0001）。11例（34.4%）患者在晚期出现低钠血症（血浆钠<135 mmol/l）。6例患者（19%）在第5天至第13天发生DIND。Logistic回归分析显示，晚期CSF AM浓度与低钠血症和DIND相关（95% CI：1.003-1.069，p = 0.0074和95% CT 1.003-1.052，p = 0.0108）。结论：本研究表明SAH后晚期CSF AM与低钠血症和DIND相关。(c)2008 S. Karger AG，巴塞尔。

BACKGROUND: Adrenomedullin (AM), a vasorelaxant peptide, is secreted into the cerebrospinal fluid (CSF)from the choroid plexus and can exert natriuretic effects in the kidney. CSF AM concentration is elevated 7-10 days after the onset of aneurysmal subarachnoid hemorrhage (SAH). The aim of the present study was to determine whether CSF AM concentrations correlate with hyponatremia and delayed ischemic neurological deficits (DIND) after SAH. METHODS: CSF and plasma concentrations of AM, brain natriuretic peptide, and atrial natriuretic peptide concentrations were measured in 32 patients with SAH who underwent aneurysmal clipping within 48 h of onset. CSF and blood samples were obtained from these patients during the early period (days 1-3, day 0 being regarded as the day of SAH onset) and the late period (days 8-10). RESULTS: In all patients, AM concentration during the early and late periods was significantly higher in the CSF than in the plasma (p = 0.0028 and p < 0.0001.). In addition, CSF AM concentration was significantly higher during the late period than during the early period (p < 0.0001). Hyponatremia (plasma sodium <135 mmol/l) was present in 11 patients (34.4%) during the late period, and. DIND developed in 6 patients (19%)between day 5 and day 13. Logistic regression analysis demonstrated that late-period CSF AM concentration correlated with hyponatremia and DIND (95% CI: 1.003-1.069, p = 0.0074 and 95% CT 1.003-1.052, p = 0.0108). CONCLUSIONS: The present study demonstrated that CSF AM during the late period following SAH correlates with hyponatremia and DIND.(c) 2008 S. Karger AG, Basel.