Spontan subaraknoid kanamayı takiben gelişen vazospazm sonrası serum ve serebrospinal sıvıda endotelin-1 düzeyleri

Amaç: Bu çalışmanın amacı subaraknoid kanamalı hastalarda serum ve beyin omurilik sıvısı örneklerinde endotelin-1 düzeylerini analiz etmek ve vazospazm üzerindeki etkilerini değerlendirmektir. Gereç ve Yöntem: Hastalar subaraknoid kanamayı takiben birkaç saat içinde beyin cerrahisi bölümünün yoğun bakım ünitesine yatırılan hastalar arasından seçildi. Subaraknoid kanama teşhisi serebral bilgisayarlı tomografi ve lomber ponksiyon ile konuldu. Hastaların ilk nörolojik muayeneleri Hunt-Hess sınıflamasına göre değerlendirildi ve serebral bilgisayarlı tomografi ile tespit edilen kan miktarları Fisher sınıflamasına göre derecelendirildi. Bulgular: Çalışmaya dahil edilen 20 hastanın serum ve beyin omurilik sıvısı örnekleri subaraknoid kanamanın ardından 1, 3, 5 ve 7. günlerde toplandı. Kontrol grubu olarak herhangi bir kranial vasküler hastalığı, sinir sistemi travması veya enflamatuar hastalığı olmayan 10 hasta çalışmaya dahil edildi. Örnekler mikro-ELISA yöntemi ile analiz edildi ve serumda ve beyin omurilik sıvısında endotelin-1 düzeyleri tespit edildi. Hunt-Hess sınıflamasına göre; 6 hasta Evre I, 10 hasta Evre II, 2 hasta Evre III ve 2 hasta Evre IV olarak değerlendirildi. Fisher sınıflamasına göre; 17 hasta Evre II, 3 hasta Evre IV olarak saptandı. Vasospazm, 3, 6, 11 ve 18 numaralı olgularda dijital subtraksiyon anjiyografi ile tespit edildi. Sonuç: Yaptığımız çalışmada, Fisher ve Hunt-Hess sınıflandırmalarında evre arttıkça serebral vazospazm riskinin arttığı saptanmıştır. Ayrıca endotelin-1 düzeylerinin subaraknoid kanamadan sonra arttığı ve artan endotelin-1 seviyelerinin spontan subaraknoid kanamayı takiben vazospazmda önemli bir rol oynayabileceği ortaya konmuştur.

Anahtar Kelimeler:

Endotelin-1, subaraknoid kanama, vazospazm

Endothelin-1 levels in serum and cerebrospinal fluid after vasospasm following spontaneous subarachnoid haemorrhage

Purpose: The aim of the present study was to analyse endothelin-1 levels in serum and cerebrospinal fluid samples in patients with subarachnoid haemorrhage and evaluated the effects on vasospasm. Material and Methods: The patients were selected among those who referred to intensive care unit of neurosurgery department within several hours following subarachnoid haemorrhage. Subarachnoid haemorrhage was diagnosed through cerebral computed tomography and lumbar punction. First neurological examinations of the patients were evaluated according to Hunt-Hess classification and the blood quantity was detected by cerebral computed tomography according to Fisher classification. Results: Serum and cerebrospinal fluid samples of 20 patients enrolled into the present study were collected at days 1, 3, 5, and 7 after subarachnoid haemorrhage. Ten individuals without any vascular diseases, nervous system trauma or inflammatory disease were enrolled into the study as the control group. Samples were analyzed through micro-ELISA method and endothelin-1 levels in the serum and cerebrospinal fluid were detected. According to Hunt-Hess classification, 6 patients were evaluated as Stage I, 10 patients as Stage II, 2 patients as Stage III and 2 patients as Stage IV. Seventeen patients were detected as Stage II whereas 3 patients were Stage IV according to Fisher classification. Vasospasm was detected in cases 3, 6, 11 and 18 by digital subtraction angiography. Conclusion: It was determined that as the Fisher and Hunt-Hess classifications increased, the risk of cerebral vasospasm increased. The present study revealed that endothelin-1 levels increase after subarachnoid haemorrhage and Endothelin-1 particularly may play an important role in the vasospasm following spontaneous subarachnoid haemorrhage.

Keywords:

Endothelin-1, subarachnoid haemorrhage, vasospasm,

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1. Sundt TM Jr, Kobayashi S, Fode NC, Whisnant JP. Results and complications of surgical management of 809 intracranial aneurysms in 722 cases. Related and unrelated to grade of patient, type of aneurysm, andtiming of surgery. J Neurosurg. 1982;56:753-65.
2. Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL. The international cooperative study on the timing of aneurysm surgery, part 1: overall management results. J Neurosurg. 1990;73:18-36.
3. Adams HP, Kassell NF, Torner JC, Haley EC Jr. Predicting cerebral ischemia after aneurysmal subarachnoid hemorrhage: influences of clinical condition, CT results and fibrinolytic therapy: a report of the Cooperative Aneurysm Study. Neurology. 1987;37:1586-91.
4. Mascia L, Fedorko L, Stewart DJ, Mohamed F, terBrugge K, Ranieri VM et al. Temporal relationship between endothelin-1 concentrations and cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2001;32:1185-93.
5. Ando K, Hirata Y, Togashi K, Kawamaki M, Maruno F. Endothelin-1 and endothelin-3-like immunoreactivity in human cerebrospinal fluid. J Cardiovascular Pharmacology. 1991;17:434-6.
6. Suzuki R, Masaoka E, Hirata H, Marumo F, Isotani E, Hirakawa K. The role of endothelin-1 in the origin of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg. 1992;77:96-100.
7. Bellapart J, Jones L, Bandeshe H, Boots R. Plasma endothelin-1 as screening marker for cerebral vasospasm after subarachnoid hemorrhage. Neurocrit Care. 2014;20:77-83.
8. Kessler IM, Pacheco YM, Lozzi SP, de Araujo AS Jr, Onishi FJ, de Mello PA. Endothelin-1 levels in plasma and cerebrospinal fluid of patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Surg Neurol. 2005;64:2-5.
9. Munakata A, Naraoka M, Katagai T, Shimamura N, Ohkuma H. Role of cyclooxygenase-2 in relation to nitric oxide and endothelin-1 on pathogenesis of cerebral vasospasm after subarachnoid hemorrhage in rabbit. Transl Stroke Res. 2016;7:220-7.
10. Bickford JS, Ali NF, Nick JA, Al-Yahia M, Beachy DE, Dore S et al. Endothelin-1-mediated vasoconstriction alters cerebral gene expression in iron homeostasis and eicosanoid metabolism. Brain Res. 2014;1588:25-36.
11. Cengiz SL, Erdi MF, Tosun M, Atalik E, Avunduk MC, Sönmez FC et al. Beneficial effects of levosimendan on cerebral vasospasm induced by subarachnoid haemorrhage: An experimental study. Brain Inj. 2010;24:877-85.
12. Heros RC, Zervas NT, Varsos V. Cerebral vasospasm after SAH. An update. Ann Neurology. 1983;14:599-608.
13. Knekt P, Reunanen A, Ahok A. Risk factors for SAH in a longitudinal population study. J Clin Epidemiology. 1991;44:933-9.
14. Penn DL, Witte SR, Komotar RJ, Sander Connolly E Jr. Pathological mechanisms underlying aneurysmal subarachnoid haemorrhage and vasospasm. J Clin Neurosci. 2015;22:1-5.
15. Saveland H, Sonesson B, Lujungren B. Outcome evaluation following SAH. J Neurosurg. 1986;4:191- 5.
16. Wilkins RH. Cerebral vazospasm. Contemporary. Neurosurgery. 1988:10:18-21.
17. Wirth FP. Surgical treatment of incidental intracranial aneurysms. Clin Neurosurg. 1986;33:125- 35.
18. Ecker A, Riemenschenider PA. Arteriographic demonstration of spazm of the intracranial arteries. J Neurosurg. 1951;8:660-7.
19. Griessenauer CJ, Starke RM, Foreman PM, Hendrix P, Harrigan MR, Fisher WS 3rd et al. Associations between endothelin polymorphisms and aneurysmal subarachnoid hemorrhage, clinical vasospasm, delayed cerebral ischemia, and functional outcome. J Neurosurg. 2017;26:1-7.
20. Tııt M, Birger A, Annika L, Hans VH. Increased interleukin-6 levels in cerebrospinal fluid following subarachnoid hemorrahage. J Neurosurg. 1993;78:562-7.
21. Gaetani P, Rodriguez y Baena R, Grignani G, Spanu G, Pacchiarini L, Paoletti P. Endothelin and aneurysmal subarachnoid haemorrhage: a study of subarachnoid cisternal cerebrospinal fluid. J Neurol Neurosurg Pschiatry. 1994;57:66-72.
22. Gaetani P, Tartara F, Pignatti P, Tancioni F, Rodriguez y Baena R, De Benedetti F. Cisternal CSF levels of cytokines after subarachnoid hemorrhage. Neurol Res. 1998;20:337-42.
23. Suzuki K, Meguro K, Sakurai T, Saitoh Y, Takeuchi S, Nose T. Endothelin-1 concentration increases in the cerebrospinal fluid in cerebral vasospasm caused by subarachnoid hemorrhage. Surg Neurol. 2000;53:131-5.
24. Seifert V, Loffler B, Zimmermann M, Roux S, Stolke D. Endothelin concentrations in patients with aneurysmal subarachnoid hemorrhage: correlation with cerebral vasospasm, delayed ischemic neurological deficits and volume of hematoma. J Neurosurg. 1995;82:55-62.
25. Ohlstein E, Storer B. Oxyhemoglobin stimulation of endothelin production in cultured endothelial cells. J Neurosurg. 1992;77:274-8.
26. Gallek MJ, Alexander SA, Crago E, Sherwood PR, Klamerus M, Horowitz MB et al. Endothelin-1 gene polymorphisms influence cerebrospinal fluid endothelin-1 levels following aneurysmal subarachnoid hemorrhage. Biol Res Nurs. 2015;17(2):185-90.
27. Clozel M, Breu V, Burri K, Cassal JM, Fischli W, Gray GA et al. Pathophysiological role of endothelin revealed by the first orally active endothelin receptor antagonist. Nature. 1993;365:759-61.
28. Lei Q, Li S, Zheng R, Xu K, Li S. Endothelin-1 expression and alterations of cerebral microcirculation after experimental subarachnoid hemorrhage. Neuroradiology. 2015;57:63-70.
29. Rosalind Lai PM, Du R. Role of genetic polymorphisms in predicting delayed cerebral ischemia and radiographic vasospasm after aneurysmal subarachnoid hemorrhage: a metaanalysis. World Neurosurg. 2015;84:933-41.
30. Shirakami G, Magaribuchi T, Shingu K, Kim S, Saito Y, Nakao K et al. Change of endothelin concentration in cerebrospinal fluid and plasma of patients with aneurysmal subarachnoid hemorrhage. Acta Anaesthesiol Scand. 1994;38:457-61.
31. Zimmermann M. Endothelin in cerebral vasospasm. Clinical and experimental results. J Neurosurg Sci. 1997;41:139-51.
32. Clyde BL, Resnick DK, Yonas H, Smith HA, Kaufmann AM. The relationship of blood velocity as measured by transcranial doppler ultrasonography to cerebral blood flow as determined by stable xenon computed tomographic studies after aneurysmal subarachnoid hemorrhage. Neurosurgery. 1996;38:896-905.
33. Itoh S, Sasaki T, Asai A, Kuchino Y. Prevention of delayed vasospasm by an endothelin ET-A receptor antagonist, BQ-123: change of ET-A receptor mRNA expression in a canine subarachnoid hemorrhage model. J Neurosurg. 1994;81:759-64.
34. Matsumura Y, Ikegawa R, Suzuki Y, Takaoka M, Uchida T, Kido H et al. Phosphoramidon prevents cerebral vasospasm following subarachnoid hemorrhage in dogs: the relationship to endothelin-1 levels in the cerebrospinal fluid. Life Sci. 1991;49:841-8.
35. Shigeno T, Clozel M, Sakai S, Saito A, Goto K. The effect of bosentan, a new potent endothelin receptor antagonist, on the pathogenesis of cerebral vasospasm. Neurosurg. 1995;37:87-90.
36. Armstead WN. Role of endothelin in pial artery vasoconstriction and altered responses to vasopressin after brain injury. J Neurosurg. 1996;85:901-7.
37. Barone FC, Globus MY, Price WJ, White RF, Storer BL, Feuerstein GZ et al. Endothelin levels increase in rat focal and global ischemia. J Cereb Blood Flow Metab. 1994;14:337-42.
38. Lampl Y, Fleminger G, Gilad R, Galron R, Sarova PI, Sokolovsky M. Endothelin in cerebrospinal fluid and plasma of patients in the early stage of ischemic stroke. Stroke. 1997;28:1951-5.
39. Masaoka H, Suzuki R, Hirata Y. Raised plasma endothelin in aneurysmal subarachnoid hemorrhage. Lancet. 1989;82:1402.