| Background and Objective: For severe intraventricular hemorrhage (IVH) with only conservative medical treatment, a high mortality has been proved in previous studies. Many clinical investigations have showed that intraventricular infusion of fibrinolytics-urokinase was recommended to the solution of blood clot. However, there was short of a potent proof supported by evidence-based medicine, and whether a fibrinolytic ability existing in human ventricular system has not identified. So the two questions should be cleared when an intraventricular infusion of urokinase was applied in clinical. One of them was whether the fibrinolytic ability existed in ventricular systems after IVH; and the other was whether the fibrinolytic activity of ventricular system was actually enhanced after intraventricular infusion of urokinase. In this investigation, we tried to test the dynamic changes of Urokinase plasminogen activator receptor (UPAR) and D-dimer (D-D ) in Cerebrospinal Fluid ( CSF) in IVH patients who received whether an intraventricular infusion of urokinase or not, and to answer the two questions.Materials and methods: 34 severe IVH patients with the treatment of external ventricular drainage (EVD) were randomly divided into two groups, UK group and NO-UK group. In UK group, all patients were treated with an EVD and an intraventricular infusion of urokinase, but in NO-UK group, patients with only an EVD. The CSF samples were obtained at 0 hour (h), 2 h, 4 h, 6 h and 12 h after operation of an EVD. The data were statistically analyzed with ways of Two-way ANOVA, One-way ANOVA, and Bivarite Correlation.Results:1. The dynamic changes of D-D in CSF in NO-UK groupIn NO-UK group, the contents of D-D in CSF were 2.24±0.13mg/L, 2.95±0.20mg/L and 3.34±0.15mg/L at three time porieds of 6-24 h, 24-48 h and 48-72 h after IVH respectively. The difference is significant for each time point, which suggested that the content of D-D increased with time lasted after IVH occurred.2. The changes of D-D in CSF in UK groupIn UK group, the contents of D-D was 2.75±0.36 mg/L, 3.06±0.39 mg/L, 2.97±0.37 mg/L, 3.00±0.37 mg/L, 2.83±0.35 mg/Lw at time point of Oh, 2 h, 4 h, 6 h and 12 h respectively. Compared with 0 time point, the differences were significant at 2h and 6h time points. The increased content of D-D in CSF suggested that an intraventricular infusion of urokinase could augment the ability of the fibrinolytic activity.3. The dynamic changes of UPAR in CSF in NO-UK groupIn NO-UK group, the contents of UPAR in CSF were 184.99±10.55pg/ml, 187.27±13.92pg/ml and 188.76±9.49pg/ml at three time periods 6-24 h, 24-48 h and 48-72 h after IVH respectively. The difference is not significant.4. The dynamic changes of UPAR in CSF in UK groupIn UK group, the contents of UPAR in CSF were 177.22±5.90pg/ml, 412.47±25.89 pg/ml, 367.58±37.76 pg/ml, 306.86±31.85 pg/ml and 216.25±17.10 pg/ml at 0 h, 2 h, 4 h, 6 h and 12 h after EVD respectively. Compared with 0 h, the contents of UPAR were significant higher.5. The correlation analysis of D-D and UPAR in CSFIn NO-Uk group, there was no linear correlation between the content of D-D and UPAR. However, in UK group, there was linear correlation between them. Pearson correlation coefficient r is 0.275, P=0.011.Conclusion:1. The content of UPAR in CSF in IVH patients could be measured, which showed that there actually was a substance with fibrinolytic activity in ventricular system after IVH.2. The contents of UPAR and D-D increased in CSF after IVH and could be enhanced by an intraventricular infusion of urokinase, which suggested that it was feasible to treat IVH patients with intraventricular infusion of urokinase.
|
PDF Full Text Request