| Objective:To detect the serum erythropoietin levels of spontaneous subarachnoid hemorrhage patients and dynamic changes of blood flow velocity in the middle cerebral artery by transcranial Doppler(TCD), analyze the relationship of serum EPO levels with MCV and vasospasm, to provide the experimental support for us to understand the role and treatment of EPO in the CVS,assisting with judging whether there is an appearance of cerebrovascular spasm and spasticity after spontaneous subarachnoid hemorrhage,so as to detect cerebral vasospasm at an early stage, treat it timely.Methods:1. The research set up experimental group and control group. (1) Experimental group:40 cases of spontaneous subarachnoid hemorrhage, all cases including 20 males,20 females,the age ranged from 19 to 75 years old, the average age was 52.05 i 13.27 years.①inclusion and exclusion criteria:spontaneous SAH, treated within 24h after the onset of SAH, not taking anticoagulant drugs in the past two weeks, no history of brain trauma in nearly three weeks, signed informed consent, enable to cooperate with the inspection and complete the follow-up.without hyperlipidemia,renal insufficiency,thyroid dysfunction, diabetes mellitus,history of blood diseases and life history of long-term living in the plateau region,to exclude pregnant women and who researchers believe is not suitable to participate in a clinical research.② experimental subgroups:Grouped according to the detection time at 24 hours,96 hours,1 week,2 weeks, as well as vasospasm group and non-spasm group. ③ Diagnosis:The diagnosis of subarachnoid hemorrhage is based on the symptoms, signs and brain CT results.Using CT angiography(Computed tomographic angiography,CTA),digital subtraction angiography(Digital subtraction angiography,DSA)to clarify the etiology of spontaneous subarachnoid.The diagnosis of cerebral vasospasm by TCD. ④Treatment:nimodipine was given routinely to relieve spasm,expansion and other supportive treatment as well as interventional embolization within a week after hospitalization, calcium antagonists continued to dilate blood vessels and supportive treatment after operative.(2) Control group:23 cases of normal volunteers,age ranged from 25 to 77 years,mean age was 51.87 ± 16.58 years.2. Experimental method:venous blood was obtained at the onset of 24 hours, 96 hours,1 week,2 weeks in the experimental groupand and TCD check was performed within 2 hours after the blood.Venous blood was getted in the control group after a 30 minutes’ break and TCD check was performed within 2 hours after the blood.Using chemiluminescence measured serum EPO.People who have more than two years of work experience and associate professors use TCD to measure the middle cerebral artery blood flow velocity.3.Statistical analysis:Relevant data use SPSS 18.0 software package. Measurement data were expressed as mean standard ± deviation (x±s),using t test or SNK. of variance analysis to analyze;The correlation between EPO value and spasticity use spearman rank correlation analysis.P<0.05 was considered as a statistically significant difference.Results:1.The value of serum EPO and MCV measured by TCD were respectively 13.98 ± 8.08miu/L and 122.8 ± 823.7cm/L,10.16 ± 6.65miu/L and 158.60 ± 37.56cm /L,10.34±6.12miu/L and 155.20 ± 38.00cm/L,13.79 ± 8.18miu/L and 114.88 ± 18.01cm/L at the onset of 24 hours,96 hours, one week, two weeks in the experimental group.The value of serum EPO and MCV were respectively 1.10 ± 6.42miu/L and 79.39 ± 12.40cm/L in the control group.Serum EPO value was no significant difference between the experimental group and the control group(P> 0.05).MCV value of the experimental group at each time point was significantly higher than the MCV value of control group (P<0.05).EPO value reduced,MCV value measured by TCD increased at the onset of 96 hours and one week compared with the onset of 24 hours,and the difference was statistically significant (P<0.05).Comparison of the onset of two weeks and one week,96 hours, EPO value increased,MCV values reduced, and the difference was statistically significant (P<0.05).2. The number of cases of cerebral vasospasm were respectively 26,31,30,16 at the onset of 24 hours,96 hours,1 week and 2 weeks.At different time points the value of serum EPO of spasm group and non-spasm group were respectively 9.05 ± 3.50miu/L and 23.12 ± 5.81miu/L,7.14 ± 3.75miu/L and 20.55 ± 2.48miu/L,7.32 ± 3.40miu/L and 19.37 ± 2.04miu/L 7.10 ± 2.91miu/L and 18.25±7.49miu/L, EPO values of spasm group were lower than non-spasm group,and the difference was statistically significant (P<0.05).3.The serum EPO value and the extent of vascular spasm was a negative correlation at the onset of 24 hours,96 hours,1 week, which Spearman coefficients were -0.487,-0.806,-0.564, and P <0.05,a statistically significant.Conclusion:1.The serum EPO levels changed with the onset time of SAH, declining in the early stages, reaching a minimum at 96 hours and one week, and then rising up at two weeks.The variation of MCV measured by TCD with the onset of SAH was rising in the early stages,reaching a maximumin at 96 hours and one week, and then decreasing at 2 weeks.2.SAH patients with low levels of EPO were more prone to vasospasm than patients with high levels of EPO.Endogenous EPO was involved in the suppression of CVS after SAH.3.The serum EPO levels of patients with SAH and the degree of spasticity was a negative correlation.The lower EPO levels,the more severe spasticity. Serum EPO values can be used to determine whether vascular cerebral vasospasm,and the degree of spasticity.So that we can detect cerebral vasospasm at the early stage and treat it timely. |
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