The Expression Of Von Willebrand Factor And ADAMTS13 In Aneurysmal Subarachnoid Hemorrhage

Objective: To study the clinical values of dynamic changes of von Willebrand factor and ADAMTS13 in aneurysmal subarachnoid hemorrhage .Methods: Twenty nine patients with aneurysmal subarachnoid hemorrhage admitted to Department of neurosurgery, The First Affilicated hospital of Soochow University , from April 2008 to April 2009. They were divided into delayed cerebral ischemia group (DCI group) and non-delayed cerebral ischemia group (no DCI group), or cerebral vasospasm group (CVS group) and no spasm group (no CVS group), or good prognosis group and poor prognosis group, and 20 cases of healthy people as control group. All patients underwent CT, DSA, or (and) CTA diagnosed with intracranial subarachnoid hemorrhage which is caused by aneurysm rupture. Patients were excluded from the study if they had incidence more than 72 hours admission; or had undergone surgery, interventional or conservative treatment outside the hospital; or were using of antiplatelet drugs such as aspirin, clopidogrel, or other anticoagulants such as warfarin, etc. Patients were also excluded if they had blood system diseases, or had impaired kidney or liver function, pregnant or breast-feeding, imminent death or with recent infections.Venous blood were drawn in tubes at 4 time points: after SAH (T1) , 1 day after SAH(T2) , (4±1) days after SAH(T3) , and (9±1) days after SAH(T4) to determine plasma concentrations of ADAMTS13, VWF, GMP-140 and IL-6 via enzyme-linked immunosorbent assay (ELISA). TCD was used to measure VMCA. GOS score was measured before discharge.Results: The concentration of vWF on T1, T2, T3 points after SAH were significantly higher in DCI group, CVS group and poor prognosis group compared with those of the control group. There were different in T1, T2 points in DCI group and no DCI group (P<0.05). There were significantly different between CVS group and no CVS group or good prognosis group and poor prognosis group on T2, T3 point (P<0.01). In DCI group, the concentration of plasma ADAMTS13 at the T1 time was significantly higher than the normal control group (P <0.01), and significantly higher than the no DCI group (P <0.01); and there were no difference between CVS group and no CVS group. In the poor prognosis group, the concentration of plasma ADAMTS13 at the T1 time was significantly higher than the normal control group (P <0.01). The concentration of plasma GMP-140 in the CVS group or poor prognosis group on T1, T2 time was higher than the normal control group. The concentration of plasma IL-6 in the DCI group, CVS group or poor prognosis group on T1, T2, T3 time was higher than the normal control group.Conclusions:Early plasma increased vWF and decreased ADAMTS13 activity were associated with DCI, and the decreased ADAMTS13 activity can predict the outcome. The endothelium dysfunction and platelet activation were correlated with the occurrence of DCI,CVS and clinical outcome.