目的 研究Notch1和血管内皮生长因子(VEGF)在出血性颅内动静脉畸形(AVM)中的作用.方法 回顾分析温州医学院神经外科手术治疗的AVM患者,共35例,根据病史和影像学特点,将AVM患者分为出血性AVM组(简称出血组)27例、非出血性AVM组(简称非出血组)8例,应用免疫组化、荧光实时定量PCR分别检测两组畸形血管团内Notch1和VEGF的表达差异及相关性.结果 ①在出血组和非出血组中,Notch1和VEGF在畸形血管团内皮细胞均表达明显,但两组Notch1、VEGF表达阳性率比较,差异均无统计学意义.②出血组的Notch1 mRNA水平为1.9±1.7,高于非出血组的1.5±0.6;出血组的VEGF mRNA水平为4.2±3.0,高于非出血组的2.9+2.7,但两组比较差异均无统计学意义.③ 经Spearman相关分析,颅内AVM的Notch1与VEGF的阳性细胞率(r= 0.638,P<0.05)及其mRNA水平(r== 0.611,P<0.05)均呈正相关.结论 Notch1、VEGF在出血性AVM和非出血性AVM中均表达升高;但在出血性AVM中无特异性,Notch1与VEGF可能协同参与颅内AVM的形成.%Objective To investigate the roles of Notchl and vascular endothelial growth factor (VEGF) in hemorrhage from intracranial arterovenous malformations (AVMs). Methods A total of 35 patients with intracranial AVM treated in the Department of Neurosurgery, Wenzhou Medical College were analyzed retrospectively. The patients with AVM were divided into either a hemorrhagic AVM group ( hem-orrhagic group; n = 27) or a non-hemorrhagic AVM group ( non-hemorrhagic group; n =8) according to their medical history and imaging features. The malformation nidi in both groups were detected by immuno-histochemistry and real-time fluorescence quantitative RT-PCR respectively. Results ①The mesothelial cells of Notchl and VEGF expressed significantly within the malformation nidi in the hemorrhagic group and the non-hemorrhagic group. There was no significant difference in the positive rate of Notchl and VEGF between the 2 groups. ②The Notchl mRNA level in the hemorrhagic group was 1.7 ( median, M) , and it was higher than 1. 6 in non-hemorrhagic group. The VEGF mRNA level in the hemorrhagic group was 3.7, and it was higher than 2.9 in the non-hemorrhagic group. However, there was no statistically significant difference between the 2 groups. ③Spearman correlation analysis showed that Notchl of the intracranial AVMs had correlations with the positive cells rate of VEGF ( r = 0. 638 , P < 0. 05 ) and the mRNA level ( r =rn0.611 , P<0.05). Conclusion Notchl and VEGF expressed both in hemorrhagic and non-hemorrhagic AVMs, however it has no specificity in the hemorrhagic AVMs. Notchl and VEGF may be synergistically involved in the formation of intracranial AVM.
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