クモ膜下出血患者の髄液および血清中TxB₂,6-keto PGF_1αの経時的測定

抄録

Vasospasm following subarachnoid hemorrhage is a serious problem. In spite of extensive clinical and experimental research, the pathogenesis of cerebral vasospasm is still obscure. Recent advances in prostaglandin (PG) research has contributed to the study of stroke and cerebral vasospasm. It is indicated that PG is concerned in the pathogenesis of cerebral vasospasm. Thromboxane B₂ (TxB₂) and 6-keto prostaglandin F_1α (6-keto PGF_1α) in cerebrospinal fluid (CSF) and serum in patients suffering from subarachnoid hemorrhage with or without subsequent cerebral vasospasm were measured by radioimmunoassay. The mean value of CSF TxB₂ in cases with vasospasm was 610 pg/ml, and in cases without vasospasm was 78 pg/ml. The mean value of CSF 6-keto PGF_1α in cases with vasospasm was 1, 152 pg/ml, and in cases without vasospasm was 65 pg/ml. As for serum, the mean value of TxB₂ in cases with vasospasm was 1, 672 pg/ml, and in cases without vasospasm was 346 pg/ml. The mean value of 6-keto PGF_1α in cases with vasospasm was 312 pg/ml, and in cases without vasospasm was 117 pg/ml. Sequential measurements were performed in 5 cases with vasospasm and 5 cases without vasospasm. Values of TxB₂ and 6-keto PGF_1α in the CSF were elevated at the early stage of subarachnoid hemorrhage in cases with subsequent vasospasm, and the levels of TxB₂ and 6-keto PGF_1α in the CSF decreased gradually. The value of TxB₂ in serum was elevated for 5 or 6 days after subarachnoid hemorrhage. In cases without vasospasm, TxB₂ and 6-keto PGF_1α in the CSF were constantly at low levels. In one case with vasospasm, TxB₂ and 6-keto PGF_1α levels in cisternal and ventricular CSF were compared. Cisternal CSF had higher TxB₂ and 6-keto PGF_1α values than ventricular CSF. Comparison of TxB₂/6-keto PGF_1α ratio in cases with or without vasospasm revealed no definite tendency. This study indicates that PG is closely related to cerebral vasospasm. Measurement of TxB₂ and 6-keto PGF_1α in CSF at the early stages of subarachnoid hemorrhage might be useful for the anticipation of vasospasm.