뇌동맥류성 뇌지주막하 출혈 환자에서 뇌척수액내의 Leukotriene C₄

Abstract

We have checked levels of leukotriene(LT) C₄, one of the arachidonic acid(AA) metabolites, in the lumbar, cisternal and ventricular cerebrospinal fluid(CSF) of 37 patients admitted with diagnosis of aneurysmal subarachnoid hemorrhage(SAH) and in lumbar CSF of 10 patients without aneurysmal SAH as the control group. We compared the levels of LTC₄in the CSF of the patients with aneurysmal SAH with those of the control group. We observed the changes of levels of LTC₄ periodically after the onset of SAH. We devided the data of patients with aneurysmal SAH into 3 groups according to sampling days (respectively 1-4, 5-11, 12-24 days after SAH) and the clinical spasm group was compared with that of the non-spasm gorup. We also looked for the differences in the sampling sites and the correlation between the white blood cell counts and the levels of LTC₄ in the CSF. The results of this study showed that the mean level of CSF LTC₄(±standard deviation) of the SAH group was significantly higher than that of the control group(215.59± 94.95 vs. 98.44±31.72pg/㎖, respectively :P<0.001). The level of the CSF LTC4 progressively increased upto 7-8 days after SAH and decreased thereafter in the spasm group. The level of the CSF LTC₄ of the spasm group was significantly higher than that of the nan-spasm group(239.03±49.94 vs. 163.06±64.39pg/㎖, respectively: P<0.05) in the first 4 days after SAH. There was no significant difference in the level of CSF LTC₄ in the ventricular, cisternal, and lumbar CSF statistically(196.25±61.15 vs. 222.51±101.50 vs. 233.40±100.85pg/㎖, respectively: P>0.05) even though we expected the level in the cisternal CSF to be higher than the lumbar CSF. There was no correlation between the white blood cell counts and the levels of LTC₄ in the CSF(correlation coefficient= 0.1240). From this study it is concluded that : 1) the AA metabolism via the lipoxygenase pathway is enhanced after SAH ; 2) the LTC₄ may play a role in the pathogenesis of cerebral vasospasm, especially in the early days after SAH: 3) the extraction of CSF via the extraventricular or cisternal drainage may decrease substances such as LTC4 which was thought to be vasoconstrictor material ; and 4) the granulocyte production of the LTC₄ accounts for only a small part.