Changes in the expression of vasoconstrictors in cerebrospinal fluid from patients with subarachnoid hemorrhage
CHENG Ya-wen1, GUO Yi-chen1, AN Jia-qi1, XU Gao-feng2, JIA Rui1, DENG Yong-ning1, LUO Guo-gang1
1 Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China;
2 Department of Neurosurgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
Background Cerebral vasospasm (CVS) is one of the common severe complications in patients with subarachnoid hemorrhage (SAH), as well as an independent risk factor for poor prognosis. As previous studies showed, CVS is closely related to the changes in the expression of vasoconstrictors in cerebrospinal fluid (CSF). In the present study, we measured the levels of endothelin-1 (ET-1), angiotensin Ⅱ (Ang Ⅱ) and thromboxane B2 (TXB2) in SAH patients' CSF to demonstrate the relationship with CVS. Methods A total of 18 patients with SAH were enrolled from September 2018 to January 2019. CSF samples were collected within 3 d, 3-5 d, > 5-7 d, > 7-d and ≥ 10 d after SAH. The levels of ET-1, Ang Ⅱ and TXB2 were detected by enzyme-linked immune sorbent assay (ELISA). Results The levels of Ang Ⅱ (P=0.041) and TXB2 (P=0.050) in CSF at different time points were significantly different. The level of AngⅡ at ≥ 10 d after SAH was significantly lower than that at < 3 d (P=0.009) and > 5-7 d (P=0.000) after SAH. The level of TXB2 reached the peak at > 5-7 d after SAH (P=0.036, 0.008), and then gradually decreased without significance. The level of ET-1 in CSF at different time points were not different (P>0.05, for all). Conclusions The levels of Ang Ⅱ and TXB2 in SAH patients' CSF present dynamic variation with the progression of the disease. This may be involved in the occurrence of CVS.
程娅雯, 郭益辰, 安佳琪, 徐高峰, 贾蕊, 邓永宁, 罗国刚. 蛛网膜下腔出血患者脑脊液血管收缩因子表达变化[J]. 中国现代神经疾病杂志, 2020, 20(6): 546-550.
CHENG Ya-wen, GUO Yi-chen, AN Jia-qi, XU Gao-feng, JIA Rui, DENG Yong-ning, LUO Guo-gang. Changes in the expression of vasoconstrictors in cerebrospinal fluid from patients with subarachnoid hemorrhage. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(6): 546-550.
Macdonald RL, Schweizer TA. Spontaneous subarachnoid haemorrhage[J]. Lancet, 2017, 389:655-666.
[2]
Modi NJ, Agrawal M, Sinha VD. Post-traumatic subarachnoid hemorrhage:a review[J]. Neurol India, 2016, 64:S8-13.
[3]
Javadpour M, Silver N. Subarachnoid haemorrhage (spontaneous aneurysmal)[J]. BMJ Clin Evid, 2009, 3:1213.
[4]
Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies:a systematic review[J]. Lancet Neurol, 2009, 8:355-369.
Hasegawa S, Hasegawa Y, Miura M. Current therapeutic drugs against cerebral vasospasm after subarachnoid hemorrhage:a comprehensive review of basic and clinical studies[J]. Curr Drug Deliv, 2017, 14:843-852.
[7]
Bacigaluppi S, Zona G, Secci F, Spena G, Mavilio N, Brusa G, Agid R, Krings T, Ottonello G, Fontanella M. Diagnosis of cerebral vasospasm and risk of delayed cerebral ischemia related to aneurysmal subarachnoid haemorrhage:an overview of available tools[J]. Neurosurg Rev, 2015, 38:603-618.
[8]
Li K, Barras CD, Chandra RV, Kok HK, Maingard JT, Carter NS, Russell JH, Lai L, Brooks M, Asadi H. A review of the management of cerebral vasospasm after aneurysmal subarachnoid haemorrhage[J]. World Neurosurg, 2019, 126:513-527.
[9]
Neuschmelting V, Marbacherm S, Fathi AR, Jakob SM, Fandino J. Elevated level of endothelin-1 in cerebrospinal fluid and lack of nitric oxide in basilar arterial plasma associated with cerebral vasospasm after subarachnoid haemorrhage in rabbits[J]. Acta Neurochir (Wien), 2009, 151:795-801.
[10]
Wisniewski K, Józwik-Pruska J, Bieńkowski M, Bobeff EJ, Bryl M, Ka?uzna-Czaplińska J, Jaskólski DJ. Isoprostanes as potential cerebral vasospasm biomarkers[J]. Neurol Neurochir Pol, 2018, 52:643-651.
[11]
Wanderer S, Mrosek J, Vatter H, Seifert V, Konczalle J. Crosstalk between the angiotensin and endothelin system in the cerebrovasculature after experimental induced subarachnoid hemorrhage[J]. Neurosurg Rev, 2018, 41:539-548.
[12]
Wang XD. Diagnosis of various cerebrovascular diseases[J]. Zhonghua Shen Jing Ke Za Zhi, 1996, 29:379-380.[王新德. 各类脑血管疾病诊断要点[J]. 中华神经科杂志, 1996, 29:379-380.]
[13]
Wei WK. Relationship between vasospasm and NO, ET-1 level in cerebrospinal fluid on patients with severe post-craniocerebral trauma[J]. Zhongguo Shi Yong Shen Jing Ji Bing Za Zhi, 2015, 1:5-7.[魏万昆. 重型颅脑外伤后血管痉挛与脑脊液NO及内皮素水平的关系[J]. 中国实用神经疾病杂志, 2015, 1:5-7.]
[14]
Long HQ, Gan YX, Wang P, Zheng LH, Yu QJ, Le YS. Changes and clinical significance of ET and ANG II in the plasma and CSF of patients with acute cerebral infarction disease[J]. Shi Yong Xin Nao Fei Xue Guan Bing Za Zhi, 1999, 7:218-221.[龙洪清, 甘佑先, 王萍, 郑丽华, 余起劲, 乐庸生. 急性脑梗死患者血浆和脑脊液中内皮素、血管紧张素Ⅱ的变化及临床意义[J]. 实用心脑肺血管病杂志, 1999, 7:218-221.]
[15]
Sun Q, Yang XF. Changes and significance of TXB2 in cerebrospinal fluid and plasma of patients with acute head injury[J]. Zhejiang Lin Chuang Yi Xue, 1999, 1:268.[孙勤, 杨小锋.急性闭合性颅脑损伤病人脑脊液及血浆血栓素B2含量的变化及意义[J]. 浙江临床医学, 1999, 1:268.]
[16]
Bellapart J, Jones L, Bandeshe H, Boots R. Plasma endothelin-1 as screening marker for cerebral vasospasm after subarachnoid hemorrhage[J]. Neurocrit Care, 2014, 20:77-83.
[17]
Wang ZP, Chen HS, Wang FX. Influence of plasma and cerebrospinal fluid levels of endothelin-1 and NO in reducing cerebral vasospasm after subarachnoid hemorrhage during treatment with mild hypothermia, in a dog model[J]. Cell Biochem Biophys, 2011, 61:137-143.
[18]
Peeyush Kumar T, McBride DW, Dash PK, Matsumura K, Rubi A, Blackburn SL. Endothelial cell dysfunction and injury in subarachnoid hemorrhage[J]. Mol Neurobiol, 2019, 56:1992-2006.
[19]
Konczalla J, Wanderer S, Mrosek J, Schuss P, Platz J, Güresir E, Seifert V, Vatter H. Crosstalk between the angiotensin and endothelin-system in the cerebrovasculature[J]. Curr Neurovasc Res, 2013, 10:335-345.
[20]
Wanderer S, Mrosek J, Gessler F, Seifert V, Konczalla J. Vasomodulatory effects of the angiotensin Ⅱ type 1 receptor antagonist losartan on experimentally induced cerebral vasospasm after subarachnoid haemorrhage[J]. Acta Neurochir (Wien), 2018, 160:277-284.
[21]
Honda Y, Minato H, Fujitani B, Masuda Y, Hosoki K. Alacepril, an angiotensin-converting enzyme inhibitor, prevents cerebral vasospasm in subarachnoid hemorrhage model in rats[J]. Methods Find Clin Pharmacol, 1997, 19:699-706.
[22]
Sellers MM, Stallone JN. Sympathy for the devil:the role of thromboxane in the regulation of vascular tone and blood pressure[J]. Am J Physiol Heart Circ Physiol, 2008, 294:1978-1986.
[23]
Lagier D, Tonon D, Garrigue P, Guillet B, Giacomino L, Martin JC, Alessi MC, Bruder N, Velly LJ. Thromboxane-prostaglandin receptor antagonist, terutroban, prevents neurovascular events after subarachnoid haemorrhage:a nanoSPECT study in rats[J]. Crit Care, 2019, 23:42.
[24]
Fang Y, Shao Y, Lu J, Dong X, Zhao X, Zhang J, Chen S. The effectiveness of lumbar cerebrospinal fluid drainage in aneurysmal subarachnoid hemorrhage with different bleeding amounts[J]. Neurosurg Rev, 2019, 10:1-9.
[25]
Geng L, Ma F, Liu Y, Mu Y, Zou Z. Massive cerebrospinal fluid replacement reduces delayed cerebral vasospasm after embolization of aneurysmal subarachnoid hemorrhage[J]. Med Sci Monit, 2016, 22:2404-2408.
