兰州大学机构库 >学院待认领
颅底肿瘤术后脑脊液中ET-1,NO的动态变化以及影像学特征与脑血管痉挛的相关性研究
Alternative TitleThe relationship between the dynamic changes of ET-1, NO levels in CSF , imaging features and cerebral vasospasm after skull base tumor resection
董志强
Thesis Advisor潘亚文
2008-05-22
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword颅底肿瘤 脑脊液 内皮素-1 一氧化氮 经颅超声多普勒 脑血管痉挛
Abstract目的:探讨颅底肿瘤术后脑脊液中内皮素-1(ET-1)、一氧化氮(NO)的动态变化以及影像学特征与术后脑血管痉挛(CVS)发生的关系; 方法:选择诊断明确的颅底肿瘤病人33例,术中、术后留取脑脊液标本,测定脑脊液中ET-1,NO的含量;同时行经颅超声多普勒(TCD)检查以判定CVS。术前、术后行影像学资料分析。 结果:颅底肿瘤术后发生CVS的病人第3天脑脊液中ET-1水平即有明显升高,第7天达到高峰,而后逐渐下降,CVS组ET-1水平明显高于未痉挛组(P<0.05),症状性CVS组ET-1水平高于无症状CVS组(P<0.05);颅底肿瘤术后发生CVS的病人第3天脑脊液中NO水平明显降低,术后第7-10天达到最低,而后逐渐升高,CVS组NO水平明显低于无CVS组(P<0.05),症状性CVS组低于无症状CVS组(P<0.05)。颅底肿瘤术后脑脊液中ET-1的水平与术后TCD监测的大脑中动脉平均血流速度(MCA MFV)呈正相关(r=0.419,P<0.01);颅底肿瘤术后脑脊液中NO的水平与术后TCD监测的MCA MFV呈负相关(r =-0.410,P<0.01)。肿瘤生长部位、与大血管的关系以及术后蛛网膜下腔出血与术后CVS发生关系密切,鞍区肿瘤与桥小脑角区肿瘤比较术后易发生CVS(Fisher 确切概率法,P<0.05)。肿瘤包绕、挤压颅底大血管者与无明显大血管包绕者比较术后易发生CVS(Fisher 确切概率法,P<0.05)。术后CT示发生蛛网膜下腔出血者与未发生蛛网膜下腔出血者比较易发生CVS(Fisher 确切概率法,P<0.05)。 结论: 颅底肿瘤术后患者脑脊液中ET-1水平的升高和NO水平的降低参与了术后CVS的发生,其含量与病情演变、CVS程度有关。脑脊液中ET-1水平的变化与TCD监测的MCA MFV呈正相关,与术后CVS的发生呈正相关,脑脊液中NO水平的变化与TCD监测的MCA MFV呈负相关,与术后CVS的发生呈负相关,两者可预测CVS的严重程度和判断预后。肿瘤生长部位、与大血管的关系以及术后蛛网膜下腔出血与术后CVS发生关系密切,肿瘤直径与术后CVS发生无明显相关性。
Other AbstractObjective: To evaluate the relationship between the dynamic changes of ET-1,NO levels in CSF , imaging features and cerebral vasospasm after skull base tumor resection Methods: ET-1 and NO levels in CSF were measured in 33 patients which diagnosed clearly from admission and the patients were monitored by TCD to evaluate CVS before and after operation. The preoperative and postoperative image datas were analysed. Results: After operation,CSF ET-1 levels markedly elevated in patients with CVS on day 3,and reached the peaks on day 7,then decreased gradually, CSF ET -1 levels in CVS groups were significantly higher than those without CVS groups(P<0.05),clinical CVS groups were higher than those of asymptomatic CVS groups(P<0.05); After operation,CSF NO levels decreased significantly in patients who developed CVS on day 3, and reached the bottom within 7-10d,then increased gradually, CSF NO levels in CVS groups were significantly lower than those without CVS groups(P<0.05),clinical CVS groups were lower than those of asymptomatic CVS groups(P<0.05). The level of ET-1 in CSF was positive correlation with the MCA MFV which monitored by TCD(r = 0.419,P<0.01);the level of NO in CSF was negative correlation with the MCA MFV which monitored by TCD(r =-0.410,P<0.01)。There is a close relationship between the location of tumors, the vascular of tumors,subarachnoid hemorrhage after operation and CVS after skull base tumor resection. Sellar tumours were prone to develop CVS compared to Cerebellopontine angle tumors(Fisher exact test, P <0.05). Skull base vessels were enveloped or compressed by tumors were prone to develop CVS compared to those didn’t affect on(Fisher exact test, P <0.05).The patients who postoperative CT showed subarachnoid hemorrhage were prone to develop CVS compared to those didn’t affect on (Fisher exact test, P <0.05). Conclusions: Our observation suggests that the increase of ET-1 levels and the decease of NO levels in CSF might be involved in the pathogenesis of the operation-associated CVS,and might relate to the patient’s pathogenetic condition and the degree of the CVS. The level of ET-1 in CSF was positive correlation with the MCA MFV which monitored by TCD and with the operation-associated CVS, the level of NO in CSF was negative correlation with the MCA MFV which monitored by TCD and with the operation-associated CVS. CSF ET-1, NO levels can predict the prognosis of the patients with CVS. There is a clo...
URL查看原文
Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/223032
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
董志强. 颅底肿瘤术后脑脊液中ET-1,NO的动态变化以及影像学特征与脑血管痉挛的相关性研究[D]. 兰州. 兰州大学,2008.
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