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Brain and Nerve No to Shinkei Volume 36, Issue 10 （October 1984）

Brain and Nerve 脳と神経 36巻10号（1984年10月発行）

Japanese English

原著

クモ膜下出血と凝固線溶異常—脳血管攣縮とfibrinopepeptide A,fibrinopeptide B_βについて（第1報） COAGULATION-FIBRINOLYSIS A BNORMALITIES IN ACUTE STAGE OF SUBARACHNOID HEMORRHAGE (PART 1):WITH SPECIAL REFERENCE TO THE RELATION BETWEEN CEREBRAL VASOSPASM AND FIBRINOPEPTIDE A, FIBRINOPEPTIDE B_β 東保肇 ¹ , 日野明彦 ² , 鈴木憲三 ³ , 久保哲 ² , 平川公義 ¹ Hajime Touho ¹ , Akihiko Hino ² , Kenzou Suzuki ³ , Touru Kubo ² , Kimiyoshi Hirakawa ¹ ¹京部府立医科大学脳神経外科 ²京都第二赤十字病院脳神経外科 ³京都宇治大和六地蔵病院脳神経外科 ¹Department of Neurosurgery, Kyoto Prefectural University of Medicine ²Department of Neurosurgery, Kyoto Secend Red Cross Hospital ³Department of Neurosurgery, Kyoto Yamato Rokujizou Hospital pp.1009-1014

発行日 1984年10月1日 Published Date 1984/10/1

DOI https://doi.org/10.11477/mf.1406205396

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Abstract 文献概要
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　抄録　脳血管障害急性期に凝固線溶異常が起ることはよく知られている。我々は今回クモ膜下出血患者17例を対象に，従来の凝固検査に加え，最近注目されつつあるfibrinopeptide A （以下FPA）および　fibrinopep—tide B_β（以下FPB_β）を急性期から慢性期にかけ経時的に測定した。検体はjuglar bulb （J）ならびに肘静脈（V）からの末梢血および髄液（L）から得た。発症後48時問以内の　FPA,V, J,FPB_β—V,J，およびFPA-L,FPB_β—Lは異常高値を示し，とくに発症後早期に脳死に陥った死亡群は生存群に比しFPA-J, FPB_β—V,Jは有意に高く，死亡群のFPA-JはFPA-Vより高値を示す傾向があった。またFPA,FPB_βは発症後3〜5日のいわゆる脳血管攣縮の発現時期に一致して高値を示したのに対しfibrinogenは遅れて7日〜14日に高値を示した。symptomatic vasospasmを起した3例はいずれも症状発現の2日〜4日前にFPA,FPB_βが異常高値を示していたのが特徴的であった。以上よりFPA, FPBβはクモ膜下出血の合併症としてのvasospasmの予知に有用な指標となり得ること，さらに予後判定の指標にもなり得ると推論できる。

It is well known that abnormalities of coagula-tion and fibrinolysis frequently take place during the course of cerebrovascular diseases. In this paper, coagulation and fibrinolytic studies were performed during the course of acute stage through chronic stage of subarachnoid hemorrhage. Tested items were partial thromboplastin time, prothrom-bin time, FDP, α₂-plasmin inhibitor, antithrom-bin III, fibrinogen, besides, fibrinopeptide A (FPA), and fibrinopeptide B_β (FPB_β) which were being worthy of note.

Blood were sampled from peripheral vein (V) and internal jugular vein at jugular bulb (J). And, moreover, cerebrospinal fluid (L) were collected as possible as we could for measuring FPA and FPB_β.

The obtained results were summarized as follows;

1) Within forty-eight hours from the onset of subarachnoid hemorrhage, FPA-V, J, L and FPB_β-V, J, L were statistically higher than those of control.

2) FPA -J and FPB_β-V, J, within forty-eight hours from the onset were statistically higher in the cases with brain death than in the survived cases.

3) On the third to fifth day from the onset when so called cerebral vasospasm became appa-rent to begin, FPA and FPB_β had a tendency to be higher than other periods.

4) Increase of fibrinogen delayed from the peaks of FPA and FPB_β showing the peaks at the seventh to the fourteenth day from the onset of subarchnoid hemorrhage.

5) In three cases with symptomatic vasospasm, FPA and FPB_β showed maximal values two to four days prior to the appearance of symptomatic cerebral vasospasm.

6) Other tests were all within normal limits. From these facts, FPA and FPB_β will be useful indeces for predicting so called cerebral vaso-spasm and their immediate prognosis.