摘要
目的研究海马区微循环障碍在蛛网膜下腔出血(SAH)后认知障碍中的作用及其机制。方法选取2017年1月至2019年1月绍兴市人民医院收治的138例SAH患者为研究对象,根据发病6个月后蒙特利尔认知评估量表评分,存在认知障碍(≤26分)63例,无认知障碍(>26分)75例;在发病后10 d进行CT灌注成像检查并比较两组患者双侧海马区脑血流量(CBF)、脑血容量(CBV)、对比剂平均通过时间(MTT)和达峰时间(TTP)等灌注参数。将30只小鼠按随机数字表法随机分为两组:模型组20只,采用线拴法血管内穿刺建立SAH模型;假手术组10只,不作血管内穿刺。建模前及建模成功后10 d采用水迷宫法(寻找站立平台的潜伏时间)评估认知功能,然后断头取脑,切取海马组织进行原位末端转移酶标记技术(TUNEL)染色,评估海马区细胞凋亡情况。结果与无认知障碍组比较,认知障碍组患者双侧海马区CBF下降,MTT、TTP均明显延长,差异均有统计学意义(均P<0.05);两组患者双侧海马区CBV比较,差异均无统计学意义(均P>0.05)。模型组20只小鼠中,存在认知障碍8只,无认知障碍12只;认知障碍组潜伏时间较无认知障碍组明显延长(P<0.05)。荧光显微镜下可见模型组小鼠海马CA3区存在较多凋亡细胞,而假手术组仅见少量凋亡细胞;与无认知障碍组相比,认知障碍组小鼠凋亡细胞数明显增多,差异有统计学意义(P<0.05)。结论SAH后早期双侧海马区即存在明显的微循环障碍和细胞凋亡增加,海马区持续微循环障碍进而导致神经元凋亡可能是SAH后发生认知障碍的发病机制之一。
Objective To study the role and mechanism of microcirculation disturbance of the hippocampus in cognitive dysfunction after subarachnoid hemorrhage.Methods One hundred and thirty-eight patients with SAH admitted to Shaoxing People's Hospital from January 2017 to January 2019 were selected as the research objects.According to the MOCA scale score 6 months after onset,63 cases had cognitive dysfunction(≤26 points)and 75 cases had no cognitive dysfunction(>26 points),CT perfusion imaging was performed 10 days after onset and then cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and time to peak(TTP)were compared between the two groups.Thirty mice were divided into two groups byrandom number table.The SAH model was established by suture in 20 mice in the model group,while 10 mice in the sham operation group were not given intravascular puncture.Pre-modeling and 10 days after modeling,the cognitive function was evaluated by water maze(latency time of searching for standing platform).Then the mice were decapitated and the hippocampal tissues were stained with TUNEL to evaluate the apoptosis of hippocampal cells.Results Compared with the non-cognitive dysfunction group,CBF in bilateral hippocampus of cognitive dysfunction group decreased,MTT and TTP were significantly prolonged,the differences were statistically significant(P<0.05),there was no significant difference in CBV in bilateral hippocampus between the two groups(P>0.05).In the model group,8 mice had cognitive dysfunction and 12 mice had no cognitive dysfunction,the latency time of cognitive dysfunction group was significantly longer than that of non-cognitive dysfunction group(P<0.05).Under fluorescence microscope,there were more apoptosis cells in CA3 area of hippocampus in model group,but only a few apoptotic cells in sham operation group.Compared with the non-cognitive dysfunction group,the number of apoptotic cells in the cognitive dysfunction group was significantly increased(P<0.05).Conclusion In the early stage of SAH,there are microcirculation disturbance and more apoptotic cells in bilateral hippocampus.Persistent microcirculation disturbance in hippocampus and neuronal apoptosis may be one of the pathogenesis of cognitive dysfunction after SAH.
作者
周永志
张小兵
王建莉
俞学斌
ZHOU Yongzhi;ZHANG Xiaobing;WANG Jianli;YU Xuebin(Department of Neurosurgery,Shaoxing People’s Hospital,Shaoxing 312000,China)
出处
《浙江医学》
CAS
2020年第19期2057-2061,I0004,共6页
Zhejiang Medical Journal
基金
绍兴市卫生计生科技计划项目(2017CX006)。
关键词
蛛网膜下腔出血
认知障碍
微循环障碍
凋亡
海马
Subarachnoid hemorrhage
Cognitive dysfunction
Microcirculation disturbance
Apoptosis
Hippocampus
