缺血性卒中急性期血浆神经递质水平的
病例对照研究

摘要/Abstract

摘要：

目的通过病例对照的方式研究缺血性卒中急性期血浆神经递质水平与正常人群之间的差异，同时研究不同严重程度卒中患者的血浆递质水平的差异。方法选取连续入组、发病在14 d内的急性缺血性卒中患者，采集急性期的血样标本，通过液相色谱-高分辨质谱外标法测量比较卒中组以及正常对照组血浆内的5-羟色胺、去甲肾上腺素、谷氨酸和γ-氨基丁酸4种神经递质的浓度。同时比较不同卒中严重程度患者的4种神经递质浓度。结果共268例缺血性卒中患者入组，其急性期血浆神经递质与正常对照组相比，血浆5-羟色胺（t =2.289，P =0.023）、去甲肾上腺素（t =0.0903，P =0.367）和谷氨酸有上升趋势（t =0.277， P =0.782），γ-氨基丁酸有下降趋势（t =－4.4145，P =0.000），其中5-羟色胺和γ-氨基丁酸在两组之间的差异有显著性。中重度卒中患者血浆5-羟色胺水平显著高于轻度卒中患者（t =2.197， P =0.029）。结论缺血性卒中急性期血浆神经递质水平与正常对照相比有差异，中重度卒中患者的血浆5-羟色胺水平升高较轻度卒中患者显著。

文章导读： 本研究显示缺血性卒中急性期血浆神经递质水平有显著变化，中重度卒中患者血浆5-羟色胺水平
高于轻度卒中患者。

关键词: 缺血性卒中; 5-羟色胺; γ -氨基丁酸; 去甲肾上腺素; 谷氨酸

Abstract:

Objective To explore the differences in plasma neurotransmitter levels between acute ischemic stroke patients and normal controls, and to investigate the role of neurotransmitters in the stroke severity. Methods Consecutively recruited and less than 14 d acute ischemic stroke patients were selected. Blood samples were harvested from these subjects at the acute stage of stroke. The plasma levels of four neurotransmitters (i.e. 5-hydroxytryptamine, norepinephrine, glutamate, and γ-aminobutyric acid) were determined by using liquid chromatography-high-resolution mass spectrometry in the patients and normal controls. The neurotransmitter levels were also compared between the different stroke severity groups. Results A total of 268 patients enrolled in our study. Compared with the normal controls, the patients with acute ischemic stroke had significantly higher level of 5-hydroxytryptamine (t =2.289, P =0.023) and lower level of γ-aminobutyric acid (t =-4.4145, P =0.000); however, there were no significant differences in the levels of norepinephrine (t =0.0903, P =0.367) and glutamate (t =0.277, P =0.782) between these two groups. Compared with the mild stroke severity patients, the patients with moderate or severe stroke had a significantly higher level of 5-hydroxytryptamine (t =2.197, P =0.029). Conclusion The plasma neurotransmitter levels differ between acute ischemic stroke patients and normal controls. Increased concentration of 5-hydroxytryptamine is correlated with stroke severity.

Key words: Ischemic stroke; 5-hydroxytryptamine; γ-aminobutyric acid; Norepinephrine; Glutamate

王展，石玉芝，王安心，张宁，王春雪，王拥军. 缺血性卒中急性期血浆神经递质水平的
病例对照研究[J]. 中国卒中杂志, 2014, 9(07): 578-582.

WANG Zhan, SHI Yu-Zhi, WANG An-Xin, ZHANG Ning, WANG Chun-Xue, WANG Yong-Jun.. Plasma Neurotransmitter Levels in Patients with Acute Ischemic Stroke: A Case-control
Study [J]. Chinese Journal of Stroke, 2014, 9(07): 578-582.

参考文献

1 解登梅, 刘晓晴, 李敏, 等. 缺血性脑卒中与神经递质

的关系[J]. 中外医学研究, 2011, 9:154-157.

2 Werner FM, Covenas R. Classical neurotransmitters

and neuropeptides involved in major depression:a

review[J]. Int J Neurosci, 2010, 120:455-470.

3 侯晶晶, 张宁, 陈立云, 等. 卒中后抑郁的发病机制研

究进展[J]. 中国卒中杂志, 2010, 5:852-856.

4 岳莹莹, 袁勇贵, 张志, 等. 卒中后抑郁新的病因假

说——谷氨酸能障碍[J]. 中国卒中杂志, 2014, 9:38-42.

5 Kunitz SC, Gross CR, Heyman A, et al. The pilot

Stroke Data Bank:definition, design, and data[J].

Stroke, 1984, 15:740-746.

6 Tei H, Uchiyama S, Usui T. Clinical-diffusion

mismatch defined by NIHSS and ASPECTS in nonlacunar

anterior circulation infarction[J]. J Neurol,

2007, 254:340-346.

7 Fonarow GC, Saver JL, Smith EE, et al. Relationship

of National Institutes of Health Stroke Scale to 30-

day mortality in medicare beneficiaries with acute

ischemic stroke[J]. J Am Heart Assoc, 2012, 1:42-50.

8 Cheng FC, Kuo JS, Chang WH, et al. Rapid and

reliable high-performance liquid chromatographic

method for analyzing human plasma serotonin,

5-hydroxyindoleacetic acid, homovanillic acid and

3,4-dihydroxyphenylacetic acid[J]. J Chromatogr,

1993, 617:227-232.

9 李建纲, 张巧俊, 高敬龙, 等. 脑卒中后抑郁患者血

5-羟色胺含量的研究[J]. 中国临床神经科学, 2007,

15:129-132.

10 Wester P, Dietrich WD, Prado R, et al. Serotonin

release into plasma during common carotid artery

thrombosis in rats[J]. Stroke, 1992, 23:870-875.

11 Cvejic V, Kumami K, Spatz M. Effect of cerebral

ischemia on synaptosomal uptake and release of 3H-5-

hydroxytryptamine in adult and young Mongolian

gerbils[J]. Metab Brain Dis, 1990, 5:1-6.

12 Wester P, Puu G, Reiz S, et al. Increased monoamine

metabolite concentrations and cholinesterase activities

in cerebrospinal fluid of patients with acute stroke[J].

Acta Neurol Scand, 1987, 76:473-479.

13 Smirne S, Franceschi M, Truci G, et al. Homovanillic

acid and 5-hydroxyindoleacetic acid modifications

in CSF of patients with stroke and multi-infarct

dementia[J]. Stroke, 1985, 16:1003-1006.

14 汪昌树, 顾统元, 黎明. 急性脑卒中患者血浆5-羟色

胺等物质改变的临床意义[J]. 卒中与神经疾病, 1999,

3:176-177.

15 陶永苍, 贾磊华, 臧贺川, 等. 脑超慢涨落图技术检测

急性脑梗死患者脑内神经递质变化特点研究[J]. 中国

全科医学, 2012, 15:2424-2427.

16 袁怀武, 张宁, 王春雪, 等. 血浆神经递质与出血性卒

中急性期抑郁相关性研究[J]. 中华内科杂志, 2013,

52:675-678.

17 李英杰, 黄勇华, 武晓玲, 等. 脑梗死病人血清及脑脊

液γ-氨基丁酸的含量变化[J]. 解放军医学杂志, 1996,

34:433-434.

18 Serena J, Leira R, Castillo J, et al. Neurological

deterioration in acute lacunar infarctions:the role of

excitatory and inhibitory neurotransmitters[J]. Stroke,

2001, 32:1154-1161.

19 Glodzik-Sobanska L, Slowik A, Kozub J, et al. GABA

in ischemic stroke. Proton magnetic resonance

study[J]. Med Sci Monit, 2004, 10 Suppl 3:88-93.

20 Castillo J, Davalos A, Naveiro J, et al. Neuroexcitatory

amino acids and their relation to infarct size and

neurological deficit in ischemic stroke[J]. Stroke, 1996,

27:1060-1065.

21 Davalos A, Castillo J, Serena J, et al. Duration of

glutamate release after acute ischemic stroke[J].

Stroke, 1997, 28:708-710.

22 Aliprandi A, Longoni M, Stanzani L, et al. Increased

plasma glutamate in stroke patients might be linked to

altered platelet release and uptake[J]. J Cereb Blood

Flow Metab, 2005, 25:513-519.

23 Leonardis L, Ogulin M, Osredkar J, et al. Plasma

norepinephrine and epinephrine concentrations in the

acute phase of ischemic stroke in an elderly group of

patients[J]. Cerebrovasc Dis, 1994, 4:398-401.

24 Chollet F. Pharmacologic approaches to cerebral aging

and neuroplasticity:insights from the stroke model[J].

Dialogues Clin Neurosci, 2013, 15:67-76.

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