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Brain and Nerve No to Shinkei Volume 44, Issue 6 （June 1992）

Brain and Nerve 脳と神経 44巻6号（1992年6月発行）

Japanese English

原著

慢性硬膜下血腫の発生機序に関する組織修復因子の意義—フィブロネクチンとその関連物質 Significance of the Factors in Wound Healing for the Origin of Chronic Subdural hematoma : Fibronectin and its Related Substances 西田伸 ¹ Shin Nishida 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 キーワード： fibronection , factor XIII , wound healing , chronic subdural hematoma Keyword: fibronection , factor XIII , wound healing , chronic subdural hematoma pp.565-570

発行日 1992年6月1日 Published Date 1992/6/1

DOI https://doi.org/10.11477/mf.1406900350

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Abstract 文献概要
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　慢性硬膜下血腫内容における血液凝固第XIII因子（F XIII），フィブロネクチン，α₂プラスミンインヒビター（α₂—PI）の濃度を測定し，さらに血腫被膜のフィブロネクチンの局在を免疫組織学的に検索した。これらの結果から血腫の成因や生活史との関連をさぐった。対象は穿頭術で治療を行った慢性硬膜下血腫患者60例で，手術時採取した血腫内容液と硬膜と一塊に摘出し得た血腫被膜13例である。血腫内容のフィブロネクチンは典型的血腫では血漿正常範囲以上の例が多かったが，F XIIIおよびα₂—PIは極めて低値であった。血腫内容の組織修復因子は治癒過程を考えると極めて不利な条件下にあった。血腫被膜におけるフィブロネクチンの存在から，被膜は治癒過程が遷延化した肉芽組織と考えられた。これら組織修復因子の不均衡状態が慢性硬膜下血腫の成因とnatural historyに大きく関与していると推察された。

The role of substances for wound healing in chronic subdural hematoma was investigated. Fi-bronectin, blood coagulation factor XIII (F XIII), az -plasmin inhibitor ( α₂-PI) and α₂-PI plasmin com-plex (PIC) in hematoma fluid were measured. sixty cases of hematoma fluid (15 cases were bilateral chronic subdural hematomas) were used for analy-sis. The levels of fibronectin in hematoma fluid ranged widely from 40 to 1068μg/ml. The levels of F X III (except 1 case) in the hematoma fluid were less than 70% (normal plasma level 72-144%). And also the levels of α₂-PI in the hematoma fluid were lower than that in normal blood plasma (85-115%). Fibrin, fibronectin, α₂-PI and collagen crosslinks to these proteins by the catalytic action of the activated F X III.

These substrate proteins (except fibronectin) and F XIII were extremely low levels for wound healing.

Histological analysis of the membrane with dura mater obtained from 13 patients was performed by Abidin-Biotin peroxydase Complx Method. Fi-bronectin was identified in outer membrane espe-cially in sinusoidal layer. In normal wound healing, fibronectin appears early with the invading fibrob-last and disappeares within 5 weeks from injury. But in chronic subdural hematoma it was not disappeares in 8 weeks after the head injury. The fact indicates the neomembrane of the chronic sub-dural hematoma is not in healing stage. This condi-tion in chronic subdural hematoma is unfavorable for wound healing.

Thus, author suspected that in early phase of wound healing after the head injury fibronectin and its related substances may play a role in the forma-tion of chronic subdural hematoma.