| Subarachnoid hemorrhage(subarachnoid hemorrhage SAH)is a high morbidity and high mortality after stroke,the incidence of acute stroke accounted for about 10%-15%.In patients,patients after being rushed to the hospital and get timely medical treatment before they died,in addition and a large part of the patients will die within two weeks after the onset,even eventually won the survival of patients,there will be a considerable part of the patients with moderate to severe neurological dysfunction.After subarachnoid hemorrhage,the patients with brain injury were divided into primary injury and secondary injury.Hematoma accounted for continue induced damage increases as the primary brain injury effect and hematoma,and caused by a variety of cellular immune response,oxidation stress reaction,inflammatory reaction and apoptosis parallel mechanism of damage to secondary brain injury.TRBs gene is a kind of protein gene was first discovered in 2003 in Drosophila family.Three members of the human TRBs family include:TRB1(also known as c8fw,GIG2 or SKIP1),TRB2(also called c5fw)and TRB3(also known as NIPK,receiver or SKIP3).The TRBs family is a kind of serine/threonine kinase kinase characteristic of this kind of false false,is the lack of obvious structural protein kinase activity.They consist of a central region with a serine/threonine protein kinase,as well as a C-terminal that consists of N-amino acid residues and 25 residues at the 70?100 terminus.TRBs central region has no key amino acid residues,so there is no kinase activity.But because the TRBs structure is highly similar to that of the serine/threonine like protein kinase,it can be achieved through the action of a real serine/threonine protein kinase.Trbs family members,trbl in skeletal muscle,pancreas,peripheral blood white cells and bone marrow expression highest TRB2 in thyroid expressed highest in peripheral white blood cells also have certain expression;TRB3 is in the liver expression is the highest.Trbl in leukemogenesis and development play an important role in;TRB in the pathogenesis of human lipoprotein metabolism and cardiovascular disease(CVD)also play an important role;the expression of trbl will compete with the expression of NF-IL6 protein.Trbl protein mainly expressed in myeloid cells,and after subarachnoid hemorrhage,blood cells into subarachnoid space may happen rupture and death,leading to trbl protein levels in cerebrospinal fluid(CSF)is changed,so as to promote or aggravate the inflammatory reaction in a variety of biological processes.Therefore,we speculate that after subarachnoid hemorrhage TRB1 protein level in cerebrospinal fluid will change,the level of TRB1 protein may have relationship with the severity and prognosis of the disease.Accordingly,we design the clinical topics,research trbl protein in the level of changes in cerebrospinal fluid of patients with aneurysmal subarachnoid hemorrhage.Analysis its relationship with the severity and prognosis of the disease,and to explore its potential mechanism of action.The clinical study,the author hopes by analyzing of patients in different periods of cerebrospinal fluid trbl level after aneurysmal subarachnoid hemorrhage,and to explore the changes along with the time change,aneurysmal subarachnoid hemorrhage patients trbl concentration and control group differences,analysis of aneurysmal subarachnoid hemorrhage in cerebrospinal fluid of patients with trbl levels were correlated with the clinical classification,neural function score,complications and prognosis of its value as the severity of the disease diagnosis and prognosis evaluation index,through the discussion of the underlying mechanism,to disease progression in early intervention,reduce aneurysmal subarachnoid hemorrhage death and disability rate.This study collected between October since August 2015 to 2015 in our department of Neurosurgery of aneurysm spinal subarachnoid hemorrhage patients as the experimental group,the history of diseases of the nervous system(meningitis,stroke,etc.)and the existence of serious systemic diseases(diabetes,rheumatism,arthritis,malignant tumor,liver cirrhosis)were excluded A total of 35 cases of patients were included in the experiment(except 4 patients because of loss to follow-up were excluded,the remaining 31 patients respectively on subarachnoid hemorrhage occurred after the 1-3 days,4-7 days,8-10 days left cerebral spinal fluid samples).Over the same period,15 cases of patients with fracture surgery without neurological diseases in the spinal canal were taken as the control group.Included in the experimental group,respectively after subarachnoid hemorrhage occurred in 1 to 3 days,4?7d,8?10 days in the morning line of the lumbar puncture cerebrospinal fluid(CSF)1ml,control group to accept before intravertebral anesthesia take 1 ml CSF,CSF samples were collected immediately 3000 rotating centrifugal 10 minutes after stored at minus 80 degrees refrigerator,by enzyme linked immune sorbent analysis method(ELISA)for the detection of the acquisition of trbl concentration in cerebrospinal fluid.all specimens were detected.Statistics of patients age.gender and other general information,and admission hunt Hess grade,Fisher grade,world neurosurgery(WFNS)score,peripheral blood indicators such as clinical data,after the patient is admitted to hospital were within 72 hours according to the general condition of patients,aneurysm size,shape and location considering to be closed or endovascular embolization in the treatment of individualized surgical dipping.All enrolled patients were in subarachnoid hemorrhage after 4?7d take CT angiography(CTA)and CT perfusion(CTP)further evaluation in patiPLoS ents with vasospasm and perfusion,also with transcranial Doppler(TCD)in detecting cerebral artery and internal carotid artery mean blood flow velocity(VMCA).using the measured results to determine whether patients with cerebral vasospasm.Any of the following criteria to determine the presence of cerebral vasospasm(1)in the middle cerebral artery blood flow(VMCA)>120cm/s.(2)the ratio of blood flow velocity increased by 50 cm/s(3)in the ipsilateral middle cerebral artery and internal carotid artery blood flow velocity(3)was greater than two.The prognosis was improved by Rankins score(MRS)3 months after the operation,and the prognosis was improved by months after the operation.Data collection is completed,both the application SPSS 13.0 statistical package for data analysis.measurement data with mean + standard deviation said groups were compared with single factor variance analysis,comparison between the two groups using t-test,Pearson correlation coefficient(CC)was used to evaluate the possible correlation between two groups of continuous variables.TRB level of cerebrospinal fluid in patients with clinical outcome assessment using two classification logistic regression analysis.Such as P>0.05 was judged to have no statistical significance,P<0.05 decision for the difference was statistically significant.Cerebrospinal fluid samples from 86 patients with subarachnoid hemorrhage were collected and 15 patients without neurological disease undergoing spinal anesthesia before surgery.In the control group,the expression level of TRB1 protein was higher,and the level of TRB1 in cerebrospinal fluid of patients with subarachnoid hemorrhage was lower than that in the control group.Compared with the control group,level of trbl in subarachnoid hemorrhage(1 to 3 days(experimental group 11.62+1.48 ng/ml.the control group 14.21+1.72 ng/ml.P value<0.05):bleeding after 4-7 days(experimental group 9.15 + 1.90 ne/ml.the control group 14.21+1.72 ng/ml,P<0.05);bleeding after 8?10 days(experimental group 7.55+2.59 ng/ml,the control group 14.21+1.72 ng/ml,P<0.05),the differences were significant.Patients 1-3 days of cerebrospinal fluid TRB1 concentration and MRS score,blood vessel spasm was significantly related to 4-7 days TRB1 concentration and MRS score,vascular spasm occurred,Hunt-Hess score,WFNS score was significantly related.8-10 day TRB1 concentration was significantly correlated with MRS score,Hunt-Hess score,WFNS score,and blood vessel spasm.Suggests that the lower the level of TRB1,the worse the awareness of patients,the lower the score of neurological function,the more serious the condition.In patients with aneurysmal subarachnoid hemorrhage 3 months after Mrs and 1-3 days,4-7 days cerebrospinal fluid trbl highly correlated(P<0.05),aneurysmal subarachnoid hemorrhage in patients with poor outcome(MRS score 4-6)trbl levels in CSF was significantly lower than that of patients with favourable outcome(MRS rated 1 to 3 points)(1-3 days 11.73+115 ng/ml of 10.91+2.13 ng/ml,4-7 days 9.34+1.13ng/ml to 7.30+0.87ng/ml,P<0.05),the difference is significant.Two classification logistic regression analysis showed that 1-3 days,4-7 days of cerebrospinal fluid TRB1 level is an independent risk factor for patients with poor prognosis.To conclude,1.After SAH trbl level in cerebrospinal fluid compared with the normal control group was significantly lower and with time decreased gradually;.Reduce the cerebrospinal fluid level of trbl and consciousness in patients with,incidence of disease severity and vascular spasm,trbl level is low,suggest that patients with more severe disease,more prone to vascular spasm;3.Cerebrospinal fluid level of trbl and SAH is associated with poor prognosis in patients with is independent risk factors influencing the prognosis. |
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