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目的 研究蛛网膜下腔出血患者外周血白细胞选择凝集素 (L -selectin)、内皮细胞选择凝集素 (E -selectin)、细胞间黏附分子 (ICAM -1)及血管细胞黏附分子 (VCAM -1)动态变化 ,探讨其对蛛网膜下腔出血后脑血管痉挛的预测价值。方法 发病 2 4h内的蛛网膜下腔出血病人 60例 ,男 34例 ,女 2 6例 ,平均 ( 5 6 1± 12 8)岁。根据是否发生脑血管痉挛患者分为两组 :脑血管痉挛组 2 4例 ,无脑血管痉挛组 36例。Hunt -Hess临床分级 :脑血管痉挛组Ⅱ级 8例 ,Ⅲ级 11例 ,Ⅳ 5例 ;无脑血管痉挛组Ⅰ级 9例 ,Ⅱ级 2 4例 ,Ⅲ级 3例。采用ELISA法 ,对患者发病后 1d及 3、7、14d晨肘静脉血L -SeleCtin、E -Selectin、ICAM -1、VCAM -1水平动态观察比较。结果 脑血管痉挛组患者发病后 1、3、7、14d ,E -selectin、ICAM -1水平均高于无脑血管痉挛组患者 (P <0 0 1) ,发病后 14d最高 (P <0 0 1)。两组发病后 1、3、7、14d的L -selectin、VCAM -1水平无统计学差异 (P >0 0 5 )。结论 蛛网膜下腔出血后脑血管痉挛患者外周血E -selectin、ICAM -l增加 ,外周血E -selectin、ICAM -1动态变化可作为预测脑血管痉挛发生的指征之一。
Objective To study the expression of leukocyte selectin, E-selectin, ICAM-1 and VCAM-1 in patients with subarachnoid hemorrhage Dynamic changes, to explore its prognostic value of cerebral vasospasm after subarachnoid hemorrhage. Methods 60 patients with subarachnoid hemorrhage within 24 hours after onset of onset were 34 males and 26 females with an average age of (561 ± 128) years. According to whether the occurrence of cerebral vasospasm patients were divided into two groups: cerebral vasospasm group 24 cases, no cerebral vasospasm group 36 cases. Hunt-Hess clinical grade: cerebral vasospasm group Ⅱ 8 cases, Ⅲ 11 cases, Ⅳ 5 cases; no cerebral vasospasm group Ⅰ 9 cases, Ⅱ 24 cases, Ⅲ grade 3 cases. The levels of L-Seletin, E-Selectin, ICAM-1 and VCAM-1 in the elbow vein of the patients on the 1st and 3rd, 7th and 14th days after onset were compared by ELISA. Results The levels of E-selectin and ICAM-1 in cerebral vasospasm group were significantly higher than those in non-cerebral vasospasm group at 1, 3, 7 and 14 days after onset (P <0.01) 1). The levels of L -selectin and VCAM-1 on the 1st, 3rd, 7th and 14th days after onset were not significantly different between the two groups (P> 0.05). Conclusion The increase of E-selectin and ICAM-1 in peripheral blood and the change of E-selectin and ICAM-1 in peripheral blood of patients with cerebral vasospasm after subarachnoid hemorrhage may be one of the indications for predicting the occurrence of cerebral vasospasm.