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Brain and Nerve No to Shinkei Volume 39, Issue 10 （October 1987）

Brain and Nerve 脳と神経 39巻10号（1987年10月発行）

Japanese English

原著

慢性硬膜下血腫におけるtissue plasminogen activator活性の意義 THE ROLE OF TISSUE PLASMINOGEN ACTIVATOR IN CHRONIC SUBDURAL HEMATOMAS 望月龍二 ¹ Ryuji Mochizuki ¹ ¹東京慈恵会医科大学脳神経外科 ¹Department of Neurosurgery, The Jikei University School of Medicine pp.947-952

発行日 1987年10月1日 Published Date 1987/10/1

DOI https://doi.org/10.11477/mf.1406205989

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Abstract 文献概要
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　抄録　慢性硬膜下血腫の血腫内容，血腫被膜（外膜），血腫外膜と密着する硬膜のtissue plasminogenactivator （TPA）活性を測定し，さらに病理所見との比較を行った。これらの結果と血種の成因や血腫の生活史との関連をさぐった。対象は手術時に採取した血腫内容15例，血腫外膜，硬膜26例である。血腫内容は遠沈分離後，上清をlysine-sepharose affinity chromatocolumnにて1oad後，TPAを溶出しフィブリンプレート法にて測定した。外膜，硬膜は緩衝液を加えて，ホモジナイズし同様に測定した。血腫内容のTPA活性は平均0.035±0.18IU／mlと低値であった。血腫外膜のTPA活性は55.0±39.7IU／g，硬膜のTPA活性は平均28.1±20.4IU／gであった。硬膜のTPA活性は外膜より常に低値で両者はよく相関した。硬膜，外膜ともに，外傷後40日〜60日頃，TPA活性が高い傾向を示した。外傷性硬膜下水腫が40日〜60日前後で慢性硬膜下血腫に移行することから，TPA活性亢進は血腫の成因に関与していると考えられる。病理所見との比較ではsinusoidal layerの発達しているもの程，高い傾向を示した。TPA活性の中心は血腫外膜のsinusoidal layerにあると推察される。

The role of tissue plasminogen activator (TPA) in chronic subdural hematomas was investigated. Fifteen cases of hematoma fluid and 26 cases of outer membrane and adjacent dura mater were used for the analysis, which were obtained at surgical treatment.

Isolation of TPA was done by using a lysine-sepharose affinity chromatoculumn, then, TPA was measured by a fibrin plate method.

The value of TPA in hematoma fluid was 0.035 ±0. 018 IU/ml (mean± SD), that was extremely low. The value of TPA in the dura mater was 28. 1± 20. 4 IU/g, which was significantly higher than that of normal dura mater.

The values of TPA in the outer membrane were ranged widely from 12. 1 to 123. 6 IU/g (55. 0 ±39. 7 IU/g). In each case, however, TPA of the outer membrane was always higher than that of dura mater and they were highly related.

TPA value of the outer membrane was tend to be high in the patients who had an obvious history of head injury and were treated surgically 40 to 60 days after the head injury. Some cases of posttraumatic subdural fluid collection were re-ported to be evoluted to chronic subdural hema-tomas at around 60 days after the head injury. From these facts, the changes of TPA activity may play a role in the evolution of chronic subdural hematomas.

In relation to the pathological findings, TPA value was tend to be high in the cases that had a well developed sinusoidal layer. Since main location of TPA is in the endothelium, this result suggests that the sinusoidal layer may produce TPA.