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ABSTRACT
AIm: Dendroaspis natriuretic peptide (DNP) is the most recently identified member of the natriuretic peptide family. Although DNP has similar
structure and function to other members, it is genetically different. The other members are known to cause vasorelaxation but the effects of
DNP on vascular structure still remains unclear. In this study, we aimed to find out the role of DNP in the development of vasospasm following
aneurysmal SAH (subarachnoid hemorrhage).
MaterIal and Methods: DNP levels of 17 patients diagnosed with aneurysmal SAH and 25 volunteers as control were measured. All SAH
patients were treated with aneurysm clip. Five ml of venous blood sample was obtained on postoperative 1, 3 and 7th days from each patient.
Additionally, DNP levels were determined by obtaining cerebrospinal fluid (CSF) postoperative 1, 3 and 7th days.
Results: Statistically significant difference was observed between cerebrospinal fluid DNP levels on day 1 and day 3 (P<0.05).
ConclusIon: This study suggests that DNP can be anticipated among molecules leading development of vasospasm. The findings of present
study are believed to encourage further studies regarding receptors and receptor specific drugs.
Keywords: Dendroaspis natriuretic peptide, Vasospasm, Aneurysmal subaracnoid hemorrhage
Z
AMA: Dendroaspis natriretik peptid (DNP), natriretik peptid ailesinin en yeni yesidir. Yapsal olarak dier yelerine benzemesine ramen
genetik olarak farkldr. Dier yelerin vazorelaksasyona neden olduu bilinmesine ramen DNP nin insann vaskler yapsndaki etkisi
bilinmemektedir. Bu almada Anevrizmal SAH (subaraknoid hemoraji) sonras vazospazm geliiminde DNP nin rolun aratrdk.
YNTEM ve GERELER: Anevrizmal SAH tans konan 17 hasta ve 25 gnll kontrol grubunda DNP dzeyleri aratrld. Tm SAH hastalar
anevrizma klibi ile tedavi edildi. Postoperatif dnemde 5ml venz kan 1., 3., 7. gnlerde alnd. 1., 3., 7. gnlerde Beyin Omurilik Svs (BOS)
alnarak DNP dzeyleri incelendi.
BULGULAR: Olgularn 1.gn BOStaki DNP dzeyleri 3.gndeki DNP dzeylerinden anlaml derecede yksektir (P<0,05).
SONU: Bu alma, DNPnin vazospazm gelimesinde etkenlerden biri olabileceini dndrmektedir. almamzn gelecekte reseptr
dzeyinde yaplacak almalar ve bu reseptrlere zg yeni ila almalarn cesaretlendireceine inanmaktayz.
ANAHTAR SZCKLER: Dendroaspis natriretik peptid, Vazospazm, Anevrizmal subaraknoid kanama
Introduction
Cerebral vasospasm that develops following subarachnoid
hemorrhage (SAH) is an important pathological condition
primarily affecting morbidity and mortality, and leading
to dramatic consequences. Vasospasm occurs clinically in
approximately one-third of patients with aneurysmal SAH,
peaks in incidence at 3 to 7 days after the hemorrhage, and
causes delayed cerebral ischemia (4). Along with vasospasm
marked natriuresis and diuresis occur leading in hyponatremia and hypovolemia, which cause further deterioration of
cerebral perfusion (5,16). Clarification of the pathogenesis of
natriuresis and diuresis in SAH cases might lead identification
of novel molecules for treatment aimed reducing the morbid-
38
Statistical Analysis
The obtained data was analyzed using SPSS (Statistical
Package for Social Sciences) for Windows 10.0 software
Patient
Age
no.
Sex
Comorbidity
Antihypertensive
Medication
Abnormal Electrolyte
at Admission
Smoker
57
Hypertension,
diabetes mellitus
Candesarten
No
No
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
70
58
66
65
43
58
50
16
47
45
57
29
47
40
49
60
F
M
F
M
F
F
M
M
M
F
M
M
M
F
M
M
None
None
None
None
None
None
None
None
Hypertension
Hypertension
None
None
Hypertension
None
Hypertension
None
None
None
None
None
None
None
None
None
None
None
None
None
None
None
None
None
No
No
No
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
Yes
No
No
No
No
Yes
Yes
Yes
Yes
No
No
Yes
Yes
39
Patient
no.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Day 1
1
0.5
0.7
1.1
1.9
1.6
0.5
0.8
0.8
0.7
0.7
0.7
0.5
0.7
0.5
0.8
0.7
Day 1
1.1
0.8
1.1
1.4
0.8
0.7
1.7
9.2
8.3
1.2
4.8
0.5
0.8
0.8
9.9
0.9
1.1
Day 3
2
0.6
1.9
1
1
0.7
0.6
0.7
0.5
0.4
0.4
6.5
0.6
0.8
0.5
0.3
0.8
Day 7
2.1
0.6
0.8
1.1
1.8
0.6
0.6
0.6
0.3
0.8
0.7
0.5
0.6
3.1
0.6
0.3
0.6
Day 3
1.8
1.9
1.9
1.1
1.9
1
1.8
7.1
25.2
1.7
6.3
5.1
3.8
6.2
7.7
3
7.7
Patient no.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Day 1
100
86
78
102
97
87
82
118
94
101
98
110
78
117
92
116
108
Day 2
130
92
94
142
135
90
76
146
118
131
126
128
86
120
107
146
128
Day 3
96
81
84
131
106
138
78
137
145
138
133
122
91
138
129
138
131
40
Day 7
0.7
0.7
1.9
1.9
0.7
0.9
0.9
6.9
30
5.8
7.6
0.6
4
4
5
0.9
1.3
Vasospasm
Hyponatremia
Fluid Balance
Day 4
Not observed
Not observed
Day 4
Day 5
Day 9
Not observed
Day 3
Day 7
Day 9
Day 6
Day 5
Not observed
Day 5
Day 7
Day 4
Day 4
130
No
No
No
No
No
No
128
130
No
No
125
No
No
130
No
No
neg.
neg.
neg.
neg.
distributed. Wilcoxon signed rank test was used for intragroup comparisons of not normally distributed parameters.
The chi-square test was used to compare qualitative data.
Probability values of less than 0.05 (p<0.05) were considered
statistically significant.
RESULTS
The study group of 42 cases consisted of 20 (47.6%) females
and 22 (52.4%) males. The participants divided into two
groups as case/SAH patients (n=17) and control (n=25). The
ages of participants were ranged from 16 to 85 year with a
mean age of 44.8317.66 years. All SAH patients were treated
with aneurysm clip ligation, and none of them was treated
with coil embolization. Among SAH patients 13 (76.5%)
showed vasospasm. The occurrence time of vasospasm
ranged between 1 day and 7 days, with a mean of 2.85
1.91 days. There was no statistically significant relationship
between mean age and sex distribution of participants from
case and control groups (p> 0.05) (Table V).
Levels of Blood DNP (Aneurysmal SAH Patients and
Controls)
There was no statistically significant difference between
serum DNP levels of SAH patients and control group measured
on days 1, 3, and 7 (p>0.05) (Table VI).
For the case group subjects; no statistically significant change
was observed between blood DNP levels of day 1 compared
with those of day 3 (p>0.05).
There was no statistically significant change between SAH
patients blood DNP levels of day 1 and day 7 (p>0.05).
Turkish Neurosurgery 2014, Vol: 24, No: 1, 38-43
Age
42
25
21
42
24
23
35
20
30
24
41
28
55
85
43
70
71
65
32
45
45
75
18
23
44
Gender
M
F
M
F
F
M
F
F
F
F
M
M
M
F
M
M
F
F
M
M
F
F
F
M
M
DNP level
0.7
0.9
0.4
0.7
0.8
0.9
0.6
0.7
0.7
0.4
0.6
0.8
0.7
0.5
0.6
0.6
2.0
0.6
0.8
0.3
0.6
0.5
0.6
0.7
0.7
Age
Gender
Female
Male
Controls (MeanSD)
41,0419,27
n (%)
13 (52.0%)
12 (48.0%)
Test; p
t:1,728 p:0,092
2:0,475 p:0,491
SAH Patients
MeanSD
Median
0.830.38
0.7
1.131.46
0.7
0.920.74
0.6
p:0.875
p:0.817
p:0.860
Controls
MeanSD
0.700.31
0,700.31
0.700.31
Median
0.7
0.7
0.7
Test ; p
Z:-1.412 p:0.158
Z:-0.493 p:0.622
Z:-0.171 p:0.865
41
SAH patients
MeanSD
Median
2,653,25
1,1
5,015,74
3
4,347,02
1,9
p:0,015*
p:0,205
p:0,205
Table VIII: Association between Blood DNP Levels and Cerebral Vasospasm
Blood DNP
Levels (ng/ml)
Day 1
Day 3
Day 7
Cerebral Vasospasm
Observed (n=13)
MeanSD
0,920,40
1,201,65
1,010,83
Median
0,8
0,7
0,6
Median
0,5
0,6
0,6
Test; p
Z:-2,453 p:0,014*
Z:0,000 p:1,000
Z:-0,294 p:0,769
Table IX: Association between CSF DNP Levels and Cerebral Vasospasm
CSF DNP
Levels (ng/ml)
Day 1
Day 3
Day 7
Cerebral Vasospasm
Observed (n=13)
MeanSD
3,133,60
5,836,37
5,107,91
Median
1,1
5,1
1,9
Median
0,9
1,9
1,4
Test; p
Z:-0,571 p:0,568
Z:-0,852 p:0,394
Z:-0,684 p:0,494
42
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