本文選題：動脈瘤性蛛網(wǎng)膜下腔出血（aSAH） + 腦血管痙攣（CVS）　； 參考：《桂林醫(yī)學院》2014年碩士論文

【摘要】：目的：本課題旨在通過對動脈瘤性蛛網(wǎng)膜下腔出血患者血清中sICAM-1含量變化的動態(tài)檢測，比較動脈瘤性蛛網(wǎng)膜下腔出血患者與正常健康成人血清中sICAM-1濃度含量差異，分析動脈瘤性蛛網(wǎng)膜下腔出血患者血清中的sICAM-1濃度含量變化與腦血管痙攣發(fā)生的時項、程度的相關(guān)性，探討其作為病情判斷、療效觀察、臨床治療及預(yù)后的有效指標的可行性，以降低動脈瘤性蛛網(wǎng)膜下腔出血后腦血管痙攣發(fā)生率以及致死、致殘率。 方法:收集桂林醫(yī)學院附屬醫(yī)院神經(jīng)外科自2012年3月至2013年5月之間收治的動脈瘤性蛛網(wǎng)膜下腔出血患者30例（實驗組）。對照組為同期來我院健康成人體檢者10例。實驗組患者入院后，于發(fā)病后1～3d(術(shù)前),7～9d,11～13d清晨空腹抽取外周靜脈血10ml，對照組抽取靜脈血的數(shù)量、方法同上，集中檢測。收集年齡、性別、Hunt分級、Fisher分級、各項檢查報告資料等，患者入院后均在72h內(nèi)予以血管內(nèi)栓塞治療。在患者發(fā)病后1～3d(術(shù)前),7～9d分別用TCD檢測大腦中動脈平均血流速度(VMCA)，利用所測得的血流速度來判斷有無腦血管痙攣的發(fā)生。將任何一次大腦中動脈血流速度(VMCA)120cm/s判定為腦血管痙攣。采用酶聯(lián)免疫吸附劑測定分析方法(ELISA)檢測所采集血清中sICAM-1濃度，術(shù)后預(yù)后（6～12月復(fù)查或電話回訪）進行GOS評分。統(tǒng)計學處理方法應(yīng)用spss12.0統(tǒng)計包進行分析數(shù)據(jù)，計量資料以均數(shù)±標準差表示,兩組之間比較采用t檢驗,如P0.05判定為差異無統(tǒng)計學意義, P 0.05判定為差異有統(tǒng)計學意義。 結(jié)果： 1.動脈瘤性蛛網(wǎng)膜下腔出血患者血清sICAM-1濃度明顯高正常成人，尤以發(fā)病后7～9d變化最明顯，，動脈瘤性蛛網(wǎng)膜下腔出血患者出血后sICAM-1濃度水平與對照組相比，(發(fā)病后1～3d：實驗組314.21±94.92ng/ml，對照組218.14±64.33ng/ml，P值0.05；發(fā)病后7～9d：實驗組486.62±83.38ng/ml，對照組224.45±59.89ng/ml，P值0.05；發(fā)病后11～13d：實驗組295.94±64.67ng/ml，對照組231.83±76.46ng/ml，P值0.05。)統(tǒng)計學上差異有顯著性意義。 2.動脈瘤性蛛網(wǎng)膜下腔出血患者早期Hunt-Hess分級為III～IV級組血清sICAM-1含量(384.45±59.89ng/ml)高于I～II級組(288.14±64.33ng/ml)(P0.05)，統(tǒng)計學上差異有顯著性意義。 3.動脈瘤性蛛網(wǎng)膜下腔出血患者早期Fisher分級為III~IV級組血清sICAM-l含量(416.62±83.38ng/ml)高于I~II級組(294.21±94.92ng/ml)(P 0.05),統(tǒng)計學上差異有顯著性意義。 4.動脈瘤性蛛網(wǎng)膜下腔出血患者輕度腦血管痙攣組患者血清sICAM-l含量(363.51土85.32ng/ml)；中度腦血管痙攣組患者血清sICAM-l含量(543.10土79.13ng/ml)；輕重度腦血管痙攣組患者血清sICAM-l含量(694.12土77.21ng/ml)。與非痙攣組相比P 0.05，統(tǒng)計學上差異有顯著性意義。 5.動脈瘤性蛛網(wǎng)膜下腔出血患者GOS評分1～3分早期血清中的sICAM-l含量(587.00±73.55ng/ml)明顯高于4～5分組(284.07±62.34ng/ml)(P0.05),統(tǒng)計學上差異有顯著意義。 結(jié)論:動脈瘤性蛛網(wǎng)膜下腔出血患者血清中的slCAM-1含量明顯高于正常成人對照組，尤以發(fā)病后7～9d含量最高；脈瘤性蛛網(wǎng)膜下腔出血患者血清中slCAM-1含量變化可以反映患者腦血管痙攣病情的嚴重程度，腦血管痙攣程度越重, slCAM-1含量越高；動脈瘤性蛛網(wǎng)膜下腔出血早期（1～3d）Hunt-Hess分級及Fisher分級越高，血清中slCAM-1含量越高血清；動脈瘤性蛛網(wǎng)膜下腔出血早期患者血清slCAM-1含量可作為預(yù)后評估的重要指標，slCAM-1含量越高,患者預(yù)后越差。
[Abstract]:Objective : To investigate the changes of serum levels of serum soluble intercellular adhesion molecule - 1 ( ICAM1 ) in patients with aneurachnoid hemorrhage ( SAH ) and to compare the changes of the levels of ICAM1 in sera of patients with aneurachnoid hemorrhage and normal healthy adults .

Methods : 30 cases ( experimental group ) were collected from January 2012 to May 2013 in the Affiliated Hospital of Guilin Medical College from March 2012 to May 2013 .

Results :

1 . The levels of serum soluble intercellular adhesion molecule - 1 in patients with aneurachnoid hemorrhage were significantly higher than those in the control group ( 1 - 3 days after onset ) . The levels of serum soluble intercellular adhesion molecule - 1 were significantly higher than those in the control group ( 1 - 3 days after onset : 314.21 鹵 94.92ng / ml in the experimental group ) , 218.14 鹵 64.33ng / ml in the control group , and 0.05 in the control group ;
7 - 9 days after onset : 486.62 鹵 83.38ng / ml in the experimental group , 224.45 鹵 59.89ng / ml in the control group and 0.05 in the control group ;
11 - 13 days after onset : 295.94 鹵 64.67ng / ml in the experimental group and 231.83 鹵 76.46ng / ml in the control group ( P < 0.05 ) . There was significant difference in statistics .

2 . The early Hunt - Hess grade of patients with aneursmal subarachnoid hemorrhage was higher than that in group I ~ II ( 388.14 鹵 64.33ng / ml ) ( P0.05 ) .

3 . The early Fisher classification of patients with aneurachnoid hemorrhage was higher than that in group I ~ II ( 416.62 鹵 83.38ng / ml ) , which was higher than that in group I ~ II ( 294.21 鹵 94.92ng / ml ) ( P 0.05 ) .

4 . The level of serum soluble intercellular adhesion molecule - 1 ( 363.51 鹵 85.32ng / ml ) was measured in patients with mild cerebrovascular spasm in patients with aneurachnoid hemorrhage .
The levels of serum soluble intercellular adhesion molecule - 1 ( 543.10 鹵 79.13ng / ml ) in patients with moderate cerebral vascular spasm were studied .
Compared with non - spasticity group , there was significant difference in serum levels of serum soluble intercellular adhesion molecule - l ( 694.12 鹵 77.21 ng / ml ) .

5 . Compared with 4 - 5 groups ( 284.07 鹵 62.34ng / ml ) ( P < 0.05 ) , the serum levels of ICAM1 - l ( 580.00 鹵 73.55 ng / ml ) were significantly higher than those in 4 ~ 5 groups ( 284.07 鹵 62.34ng / ml ) ( P0.05 ) .

Conclusion : The content of slCAM - 1 in serum of patients with aneursmal subarachnoid hemorrhage is significantly higher than that in normal adult control group , especially in 7 锝

本文編號：1832634