血管内皮生长因子、D-二聚体对慢性硬膜下血肿的影响

目的通过检测慢性硬膜下血肿（CSDH）病人血液与硬膜下血肿液VEGF、D-dimer和FDP的含量，探讨假膜新血管生成、局部纤溶状况及其在CSDH发生、发展中的作用，并为CSDH的治疗及预防复发提供理论依据。方法采用ELISA法测定患者血清及血肿液中VEGF的含量。比较患者末梢静脉血及血肿液中四种因子的含量变化并与正常对照组比较。结果（1）病例组血肿液FDP、d-dimer检测均为阳性，血液为阴性；正常对照组血液FDP、d-dimer检测均为阴性；（2）病例组血清VEGF含量与正常对照组比较差异无统计学意义（P〉0.05）。血肿液中VEGF浓度明显高于血清中，其差异有统计学意义（P〈0.01）。结论CSDH患者血肿液局部纤溶亢进，VEGF分泌旺盛，新血管生成活跃，可导致CSDH不断扩大，可能参与CSDH发病机制。抑制VEGF的生理作用、有选择的对病人施行促凝治疗可能成为部分CSDH病人保守治疗及预防复发的有效手段。

The Affection of VEGF and D-dimer on Chronic Subdural Hematoma

Objective To explore the the states of neovascularity in pseudomembrane and local fibrinolysis and their effect in the occurrence and development of chronic subdural hematoma （CSDH） by detecting the content of vascular endothelial growth factor （VEGF）,D-dimer and FDP in the blood and hematoma fluid of the patients with CSDH so as to provide theoretical bases for the treatment and recurrence of CSDH. Methods The content of VEGF in the serum and hematoma fluid of the patients was detested by ELISA,and the content changes of the 4 factor in the peripheral blood and the hematoma fluid of the patients were compared and a contrast study was made with the control. Result（1） FDP and D-dimer in bematoma fluid of the patients in trial group were detected to be positive but negative in blood ; FDP and D-dimer in blood of the control were all negative ; （2） There existed no significant difference in VEGF contents in serum between the trial group and the control （ P 〉 0.05） ; the concentration of VEGF in hematoma fluid of the patients in trial group was obviously higher than that in serum,the difference was of significance （ P 〈 0.01）. Conclusions The hyperfunctuion of local fibrinolysis,the vigorous secretion of VEGF and the active neovascularity in hematoma fluid of the patients with CSDH may lead to the continuous enlargement of the CSDH and involve in the pathogenesis of CSDH ; it may be an effective way of conservative treatment and recurrence prevention for some patients with CSDH to inhibite the physiological function of VEGF and to provide coagulation-promotion therapy.