慢性硬膜下血腫の増大因子に関する一考察—血腫内容と被膜のCK活性の意義

GROWING FACTORS OF CHRONIC SUBDURAL HEMATOMA: SIGNIFICANCE OF CK ACTIVITY IN HEMATOMA CONTENTS AND NEOMEMBRANE

　抄録慢性硬膜下血腫増大のメカニズムは，いまだ不明の部分が多い。1回の血腫洗浄で大部分の血腫が治癒することから，血腫内容にその増大因子が存在するものと考え血腫内容の分析からその生活史を解明しょうとした。慢性硬膜下血腫52例の血腫内容のCK活性が高値を示すことに注目した。又，15例の血腫被膜の活性の局在の検索を免疫紅織学的方法で行った。慢性硬膜下血腫内容のHt, Hb値は日齢とともに高値を示す。CK活性は被膜成熟期の60日前後で高値を示し，その変動は血腫の生活史との関連が示唆された。ところが，血腫内容のCK活性の動向を裏付けるような被膜内CK活性を見いだすことはできなかった。したがって，血腫増大因子として，被膜からの出血と吸収の不均衡などに加え，血腫内容の濃縮機転などの別の要因が重要であると考えられた。

The growing mechanism of the chronic sub-dural hematoma has not fully understood yet, in spite of numerous studies about hematoma neo-membranes. However, it is well known that the majority of the chronic subdural hematomas are well healed by a simple irrigation of hematoma. These facts suggested that the hematoma contents could have important growing factors of the chro-nic subdural hematoma.

Thus, LDH and CK activities were estimated in 52 cases of hematoma contents and 15 cases of hematoma neomembranes in order to search grow-ing factors, biochemically. Hematocrit and he-moglobin values in hematoma contents were also examined simultaneously.

As a result, hematocrit and hemoglobin values in hematoma contents were gradually increased, these facts might be due to the concentration of hema-toma contents. LDH and CK activities in hematoma contents were high around 60 days after the he-matoma inducing head trauma, and these enzyme activities were not correlated with hematocrit value. In isozyme analysis of LDH and CK acti-vities, LDH-1, 2 and CK-MM showed high values but CK-BB, MB could not be recognized. These findings suggested that LDH activity in the hema-toma contents were caused by hemolysis which had been reported to be a main cause, and CK activity might originate from muscular tissues.

Therefore, author hypothesized that the CK activity in hematoma contents had originated from the neomembrane, since there was a good correla-tion between the mature stage of neomembrane and the high level of CK-MM, and the myofibro-blast was found in neomembrane recently. CK-MM could be released from the myofibroblast in neomembrane. However, CK activity in hematoma neomembrane could not be recognized, biochemi-cally nor immunohistochemically.

Thus, author suspected that the high level of CK activity in hematoma contents could be due to the concentration of hematoma contents.

It is important to study the substance exchange between the hematoma contents and neomembrane for searching the growing factors of the chronic subdural hematomas.