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背景:对于脑卒中血清一氧化氮和血浆内皮素水平的实验室和临床研究较多,但对二者比率及其意义无深入研究。目的:观察脑卒中患者血清一氧化氮和血浆内皮素水平的动态变化。设计:病例-对照观察。单位:苏州大学附属第二医院神经内科,神经病学实验室。对象:于1999-09/2001-12在苏州大学附属第二医院神经内科连续住院患者中选出急性脑梗死216例,男133例,女83例。脑出血112例,男68例,女44例。健康对照组106人,其中男63人,女43人,选自健康查体人员。方法:采用硝酸还原酶法和放射免疫分析法分别测定了328例脑卒中住院患者病程1～3d,1,2,4,8,12周和健康对照组106人的血清一氧化氮和血浆内皮素含量。主要观察指标:血清一氧化氮和血浆内皮素含量及一氧化氮与内皮素的比值。结果:①与对照组比较,脑梗死和脑出血患者急性期(1～3d内)血清一氧化氮含量明显下降并达最低值,以后逐渐上升,4周左右接近正常水平;内皮素则在急性期明显上升,2周时达峰值,其后缓慢下降,恢复期仍维持在较高水平,4～8周时才接近正常水平。②与对照组比较,脑梗死组急性期一氧化氮/内皮素于病程1～3d时已有明显下降(P<0.05),1周时下降至波谷(P<0.001),2周时已回升至正常水平;脑出血组急性期一氧化氮/内皮素下降更为明显,1～3d即显著下降(P<0.001),1周时降至波谷(P<0.001),然后逐渐上升,病程中波动较大,8周时才上升至正常偏高水平;脑出血组和脑梗死组间一氧化氮/内皮素动态变化存在明显差异(P<0.05)。结论:一氧化氮、内皮素这两种效应相反的血管作用物质在缺血性脑血管疾病和出血性脑血管疾病的发生发展中起着重要的作用,其含量改变与患者预后有关。
BACKGROUND: There are many laboratory and clinical studies on the levels of serum nitric oxide and plasma endothelin in stroke, but there is no further study on the ratio and its significance. Objective: To observe the dynamic changes of serum nitric oxide and plasma endothelin levels in patients with stroke. Design: Case-control observation. Unit: Second Affiliated Hospital of Soochow University Neurology, Neurology Laboratory. PARTICIPANTS: A total of 216 acute cerebral infarction patients (133 males and 83 females) were selected from consecutive inpatients in Department of Neurology, the Second Affiliated Hospital of Soochow University from September 1999 to December 2001. 112 cases of cerebral hemorrhage, 68 males and 44 females. Health control group of 106 people, including 63 males and 43 females, were selected from the health examination staff. Methods: Nitric acid reductase and radioimmunoassay were used to determine the serum levels of nitric oxide and plasma endothelium in 328 stroke patients hospitalized for 1 ~ 3d, 1, 2, 4, 8 and 12 weeks and healthy controls Vegetarian content. MAIN OUTCOME MEASURES: Serum nitric oxide and plasma endothelin levels and the ratio of nitric oxide to endothelin. Results: ① Compared with the control group, the levels of serum nitric oxide in acute phase (1-3 days) of cerebral infarction and intracerebral hemorrhage were significantly decreased and reached the lowest level, then gradually increased and approached the normal level in 4 weeks; while in the acute phase Period increased significantly, peaked at 2 weeks, then decreased slowly, the recovery period remained at a high level, 4 to 8 weeks before approaching normal levels. Compared with the control group, the levels of nitric oxide / endothelin in the acute phase of cerebral infarction group decreased significantly (P <0.05) at 1 ~ 3d and decreased to the trough at 1 week (P <0.001), and recovered at 2 weeks (P <0.001), and then dropped to the trough (P <0.001) at 1 week, then gradually increased. During the course of the disease, the levels of nitric oxide and endothelin were significantly decreased in the acute phase of cerebral hemorrhage group Fluctuated and increased to the normal high level at 8 weeks. The dynamic changes of nitric oxide / endothelin between cerebral hemorrhage group and cerebral infarction group were significantly different (P <0.05). CONCLUSION: The two vasoactive substances with the opposite effects of nitric oxide and endothelin play an important role in the occurrence and development of ischemic cerebrovascular disease and hemorrhagic cerebrovascular disease, and their content changes are related to the prognosis of patients.