| Objective: To study the variation of the coagulation,fibrinolytic system and mediators of inflammation in the patients with cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH), and investigate the relationship between the variation and CVS,pathogenetic turnover or prognosis。Methods :The patients resource is 31 cases of patients with subarachnoid hemorrhage from 2005~2006,male/female was 17/14,age 53.52±9.12 ,verified by CT or MRI . All cases had no infiltration or infected disease; and they were not accompanied with important organ disease such as heart, liver, lung , kidney , tumor ,immunology system disease; had no surgery, trauma or heart or head stroke in half a year. 20 cases(age59.83±7.11)normal healthy human adopted as control group. The patients were divided into 2 groups according to Hunt&Hess grade,death,Modified Rankin Scale and cerebral vasospasm respectively. After episode, the blood of the patients with SAH were collected in 1~2 days, 3~5 days and 7~10 days. All specimens were stored at–80°C to measure. Five markets of t-PA, PAI-1, VEGF, vWF, P-Selectin were tested by ELISA and the market of AT-III was tested by flocculent immunoassay. TCD was used to measure VMCA in 1~2 days,3~5 days and 7~10 days. Statistics : Statistics were performed on analysis software SPSS 10.0 .Values were expressed as mean士SD (normal distribution). Using Student t test compared continuous variables between two groups. For continuous variables, comparisons among groups were analyzed by using ANOVA.Results:①The cases with CVS in 3~5 days and 7~10 days were more than those in 1~2 days;②According to Hunt&Hess grade, the proportion of patients in III~V grade group with moderate or severe CVS was more than its in I~II grade group. According to Modified Rankin Scale, the proportion of patients in 3~5 score group with moderate or severe CVS was more than its in 0~2 score group;③The indexes of AT-III and t-PA increased obviously at early stage ,there were significant difference ,compared with control group. From 3rd day ,the indexes were decreased gradually. The levels of PAI-1,VEGF,vWF,P-Selectin raised from 1st day, and were highest in 7~10 days , all levels are significantly higher than those in the control group from 1st day except PAI-1.The level of PAI-1 was significantly higher than its in healthy controls from 3rd day;④There were significant difference between the levels of PAI-1,AT-III,VEGF,vWF in death group and those in survival group from 3rd day . Compared with all the indexes in death group and survival group, the probability values were significant from 7th day except t-PA;⑤The level of P-Selectin in 3~5 score group was significantly higher than its in 0~2 score group in 1~2 days .In 3~5 score group ,the levels of VEGF,vWF and P-Selectin were higher and AT-III was lower in significance than those in 0~2 score group in 3~5 days.From 7th day , all indexes except P-Selectin have significantly difference between two groups;⑥There were significant difference between the levels of PAI-1,AT-III,VEGF,vWF,P-Selectin in CVS group and those in non-CVS group .Conclusion:①Dynamic changes of t-PA,PAI-1,AT-III,VEGF,vWF,P-Selectin were detected in the blood of patients with CVS after SAH;②All of them are in the course of CVS after SAH by multiple paths;③We can conclude the possibility of CVS,pathogenetic turnover and the quality of life of the survivors by testing the levels of t-PA,PAI-1,AT-III,VEGF,vWF,P-Selectin. |
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