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

背景：肾上腺髓质素（AM）是一种血管松弛肽，从脉络膜丛分泌到脑脊液（CSF）中，可在肾脏中发挥尿钠作用。动脉瘤性蛛网膜下腔出血（SAH）发生后7-10天脑脊液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：测定32例发病后48小时内行动脉瘤夹闭术的SAH患者脑脊液和血浆中AM、脑钠肽和心房钠肽浓度。在早期（第1-3天，第0天被视为SAH发病日）和晚期（第8-10天）采集这些患者的脑脊液和血液样本。结果：所有患者脑脊液早、晚期AM浓度均显著高于血浆（p = 0.0028和p < 0.0001）。脑脊液AM浓度晚期显著高于早期（p < 0.0001）。11例（34.4%）患者晚期出现低钠血症（血浆钠<135 mmol/l）。6例患者（19%）在第5天至第13天发生ddd。Logistic回归分析显示，晚期脑脊液AM浓度与低钠血症和ddd相关（95% CI: 1.003-1.069, p = 0.0074, 95% CT: 1.003-1.052, p = 0.0108）。结论：本研究表明，蛛网膜下腔出血后晚期脑脊液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.