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Arachidonsäure-metabolismus nach aneurysmaruptur

Arachidonic acid metabolism following aneurysm rupture

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Summary

Imbalance between the two arachidonic acid metabolites, prostacyclin (PGI2) and thromboxane A2 (TXA2), is thought to be at least in part responsible for the development of cerebral vasospasm following aneurysm rupture. In 12 patients with subarachnoid hemorrhage the pre- and postoperative serum and CSF levels of PGI2 and TXA2 were measured as a function of their stable hydrolysis products, 6-Keto-PGF1α (PGI2) and thromboxane B2 (TXA2), with a highly specific radioimmunoassay. Serum levels of both metabolites were elevated in half of the patients, but no correlation to the clinical course could be found. However, TXB2 concentration in the CSF was significantly increased preoperatively with close correlation to the amount of intracisternal blood, as detected by CT scan. Furthermore, it could be demonstrated that the post-operative course of the TXB2 concentrations in the CSF reflects the clinical course in such a way that a characterstic secondary rise of TXB2, concentration postoperatively is closely related to the occurrence of cerebral vasospasm and clinical deterioration. The conclusion is drawn that measurement of arachidonic acid metabolites in the CSF may provide important information concerning the pathophysiological events following subarachnoid hemorrhage, especially with regard to incipient cerebral vasospasm.

Zusammenfassung

Der gestbrten Homöostase zwischen den Arachidonsauremetaboliten Prostacylin (PGI2) and Thromboxan A2 (TXA2) kommt nach experimentellen Untersuchungen eine wesentliche Bedeutung fur die Entstehung cerebraler Vasospasmen nach Subarachnoidalblutung zu. Um die klinische Relevanz dieser Hypothese zu überprüfen wurden bei 12 Patienten nach Aneurysmaruptur die prä- und postoperativen Serum- and Liquorspiegel von PGI2 and TXA2 untersucht. Die Konzentrationen beider Substanzen wurden als Funktion ihrer stabilen Abbauprodukte 6-Keto-PGF1α(PGI2) und Thromboxan B2 (TXA2) mittels eines hochspezifischen Radioimmunoassays bestimmt. Die Serumspiegel beider Metaboliten waren bei der Hälfte der Patienten prä- und postoperativ deutlich erhöht, zeigten aber insgesamt einen unspezifischen Verlauf ohne erkennbare Beziehung zum klinischen Krankheitsablauf. Demgegenuber fand sich eine eindeutige Korrelation zwischen der Höhe der initialen Liquorkonzentration von TXB2 and dent Ausmaß der comutertomographisch nachweisbaren Subarachnoidalblutung. Einem sekundaren postoperativen Thromboxan B2 Anstieg im Liquor kommt dariiberhinaus offensichtlich eine Bedeutung in der Entwicklung cerebraler Gefaf3spasmen mit nachfolgender klinischer Verschlechterung zu. Die 6-Keto-PGF1α-Spiegel waren prä- und postoperativ nur leicht bis mäßig erhöht und wurden von den gesteigerten TXB2-Konzentrationen signifikant übertroffen. Es wird geschlossen, daß dem prä- und post-operativen Monitoring von Arachidonsäuremetaboliten eine mögliche Bedeutung in der Überwachung von Patienten nach Subarachnoidalblutung zukommt, insbesondere im Hinblick auf eine frühzeitige Erkennung insipienter cerebraler Vasospasmen.

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  1. Neurochirurgische Klinik and Abteilung fur Molekularpharmakologie, Medizinische Hochschule Hannover, Konstanty-Gutschow-Strasse 8, D-3000 Hannover 61, Bundesrepublik, Deutschland

    V. Seifert, D. Stolke, V. Kaever & H. Dietz

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  1. V. Seifert
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  3. V. Kaever
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Seifert, V., Stolke, D., Kaever, V. et al. Arachidonsäure-metabolismus nach aneurysmaruptur. Eur Arch Psychiatr Neurol Sci 236, 94–101 (1986). https://doi.org/10.1007/BF00454018

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