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颅脑损伤后可引起系列的脑组织病理生理学反应,如颅内压增高、脑灌注压下降、心室容量负荷过重等,如何及早评估其疾病走向是对症治疗的关键[1]。氨基末端脑钠肽前体(N-terminal pro-B-type natriuretic peptide, NT-proBNP)与B型钠尿肽(brain natriuretic peptide,BNP)同源产生,均由神经系统下丘脑、心室等部位产生,但有研究[2-3]表明NT-proBNP在颅脑创伤后脑水肿病人中表达水平增高,可能与病人的预后相关[2-3]。而目前研究较多的是NT-proBNP与心功能衰竭方面,在颅脑损伤预后的评估中应用较少。考虑到NT-proBNP的生物半衰期较BNP长,在疾病早期可通过检测NT-proBNP评估疾病发展趋势[4],尤其是早期颅脑损伤(疾病发生后24 h内)其数值的波动,可能与疾病严重程度及预后的有一定关系。本研究选择100例颅脑损伤病人为研究对象,明确NT-proBNP是否可以用于判断脑损伤病人预疾病严重程度及预后的一项生化指标。现作报道。
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发病2 h病人的血浆NT-proBNP水平为(156.35±34.97)pg/mL,发病12、24 h,病人的血浆NT-proBNP水平分别为(192.71±42.58)pg/mL、(227.26±57.41)pg/mL,病人不同时点血浆NT-proBNP水平比较差异有统计学意义(MS组内= 2 110.621,F=59.57,P < 0.01),且病人发病12、24 h的血浆NT-proBNP水平均明显高于发病2h时(q=7.91、15.43,P < 0.01),发病24 h与发病12 h的指标比较,差异均有统计学意义(q=7.52,P < 0.01)。
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发病2、12、24 h,3组间血浆NT-proBNP水平差异均有统计学意义(P < 0.01),其中轻型组低于其他两组,中型组低于重型组(P < 0.01);3组组内在发病2、12、24 h时,血浆NT-proBNP水平比较,差异均有统计学意义(P < 0.01),其中轻症组发病12、24 h时均明显高于发病2 h时(P < 0.01),中症组发病24 h均明显高于发病2、12 h时(P < 0.01),重症组发病12 h和24 h时均明显高于发病2 h(P < 0.01),发病24 h时明显高于发病12 h时(P < 0.01)(见表 1)。
分组 n 发病2 h 发病12 h 发病24 h F P MS组内 轻型组 22 113.65±32.79 135.84±22.65△△ 142.64±21.53△△ 7.39 < 0.01 683.915 中型组 31 157.35±24.57** 163.52±27.94** 182.03±24.12**△△▽▽ 7.80 < 0.01 655.367 重型组 47 172.12±21.03**# 216.40±31.55**##△△ 241.59±23.47**##△△▽▽ 87.70 < 0.01 662.834 F — 40.97 68.57 150.97 — — — P — < 0.01 < 0.01 < 0.01 — — — MS组内 — 629.210 824.549 541.508 — — — q检验: 与轻型组比较*P < 0.05,**P < 0.01;与中型组比较#P < 0.05,##P < 0.01;同组与发病2 h前比较△P < 0.05, △△P < 0.01;与发病12 h前比较▽P < 0.05,▽▽P < 0.01 表 1 颅脑损伤严重程度与血浆NT-proBNP水平关系比较(x±s;pg/mL)
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88例预后良好,12例预后不良。发病2、12、24 h时,预后良好组的NT-proBNP水平明显低于预后不良组(P < 0.01)。2组不同发病时间NT-proBNP水平,差异均有统计学意义(P < 0.01),发病12、24 h时,2组均高于发病2 h(P < 0.01),预后良好组发病24 h高于发病12 h(P < 0.01)(见表 2)。
分组 n 发病2 h 发病12 h 发病24 h F P MS组内 预后良好组 88 101.63±27.19 161.34±38.46△△ 175.75±32.25△△▽▽ 125.13 < 0.01 1 086.176 预后不良组 12 186.51±26.35 219.54±32.78△△ 237.45±23.54△△ 10.35 < 0.01 774.327 t — 10.18 4.99 6.39 — — — P — < 0.01 < 0.01 < 0.01 — — — q检验: 同组与发病2 h前比较△P < 0.05, △△P < 0.01;与发病12 h前比较▽P < 0.05,▽▽P < 0.01 表 2 病人预后与血浆NT-proBNP水平关系比较(x±s;pg/mL)
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相关分析结果显示,血浆NT-proBNP与GCS、GOS评分均呈明显负相关关系(rs=-0.715、-0.824,P < 0.01)。
早期创伤性颅脑损伤病人血浆NT-proBNP水平与疾病严重程度及预后的关系分析
Analysis of relationship between plasma NT-proBNP level and disease severity and prognosis in patients with early traumatic craniocerebral injury
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摘要:
目的探讨创伤性颅脑损伤病人早期血浆氨基末端脑钠肽前体(NT-proBNP)水平与疾病严重程度及其预后的关系。 方法采用回顾性研究方法,选取100例创伤性颅脑损伤病人为观察组,记录病人发病2、12、24 h时的血浆NT-proBNP水平,分析其变化特点。根据病人入院时的格拉斯哥昏迷评分(GCS)将创伤性颅脑损伤病人分为轻型组、中型组、重型组,比较3组病人不同时间的血浆NT-proBNP水平,探讨血浆NT-proBNP水平与疾病的严重程度的相关性。发病30 d依据格拉斯哥预后评分(GOS)将颅脑损伤病人分为预后不良组和预后良好组,比较不同预后病人的血浆NT-proBNP水平特点。 结果发病2、12、24 h,3组间血浆NT-proBNP水平,差异均有统计学意义(P < 0.01),轻型组低于其他两组,中型组低于重型组(P < 0.01);3组组内在发病2、12、24 h时血浆NT-proBNP水平差异均有统计学意义(P < 0.01),轻型组发病12、24 h时均明显高于发病2 h时(P < 0.01),中型组发病24 h均明显高于发病2、12 h时(P < 0.01),重型组发病12 h和24 h时均明显高于发病2 h(P < 0.01),发病24 h时明显高于发病12 h时(P < 0.01)。发病2、12、24 h时,预后良好组的NT-proBNP水平明显低于预后不良组(P < 0.01)。2组发病不同时间NT-proBNP水平,差异均有统计学意义(P < 0.01),发病12、24 h时,2组均高于发病2 h(P < 0.01),预后良好组发病24 h高于发病12 h(P < 0.01)。血浆NT-proBNP与GCS、GOS评分均呈明显负相关关系(P < 0.01)。 结论创伤性颅脑损伤病人早期血浆NT-proBNP水平明显升高,且与GCS、GOS评分呈负相关关系,临床可通过上述评分指标预测病情变化。 -
关键词:
- 颅脑损伤 /
- 血浆氨基末端脑钠肽前体 /
- 预后
Abstract:ObjectiveTo investigate the relationship between early plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP) level and disease severity and prognosis in patients with traumatic craniocerebral injury. MethodsA retrospective research method was used to select 100 patients with traumatic craniocerebral injury as observation group.The plasma NT-proBNP level was recorded at 2, 12 and 24 hours of the onset, and the change was analyzed.According to Glasgow coma scale(GCS) score of patients at admission, patients with traumatic craniocerebral injury were divided into mild group, middle group and severe group.The plasma NT-proBNP level of the three groups was compared at indicated times, and the correlation between plasma NT-proBNP level and disease severity was explored.At 30 d after the onset, the patients with traumatic craniocerebral injury were divided into poor prognosis group and good prognosis group according to the Glasgow outcome scale(GOS) score, and the plasma NT-proBNP level of patients with different prognosis was compared. ResultsAt 2, 12 and 24 hours, there were significant differences in plasma NT-proBNP levels among the three groups, the mild group was lower than the other two groups, and the middle group was lower than the severe group(P < 0.01).There were significant differences in plasma NT-proBNP levels at 2, 12 and 24 hours of onset in the three groups(P < 0.01).The levels at 12 and 24 hours of onset in the mild group were significantly higher than those at 2 hours of onset(P < 0.01), the levels at 24 hours of onset in the middle group were significantly higher than those at 2 and 12 hours of onset(P < 0.01), the levels at 12 and 24 hours of onset in the severe group were significantly higher than those at 2 hours of onset(P < 0.01), and the levels at 24 hours of onset were significantly higher than those at 12 hours of onset(P < 0.01).At 2, 12 and 24 hours of onset, the NT-proBNP level in the good prognosis group was significantly lower than that in the poor prognosis group(P < 0.01).There were significant differences in NT-proBNP levels between the two groups at different times of onset(P < 0.01).At 12 and 24 hours of onset, both groups were higher than 2 hours of onset(P < 0.01), and the 24 hours of onset in the good prognosis group was higher than 12 hours of onset(P < 0.01).Plasma NT-proBNP was significantly negatively correlated with GCS and GOS scores(P < 0.01). ConclusionsThe level of plasma NT-proBNP in patients with traumatic craniocerebral injury is significantly increased in the early stage, and its expression level is negatively correlated with GCS and GOS score.The above-mentioned scores can be used to predict the changes of the disease in clinical practice. -
表 1 颅脑损伤严重程度与血浆NT-proBNP水平关系比较(x±s;pg/mL)
分组 n 发病2 h 发病12 h 发病24 h F P MS组内 轻型组 22 113.65±32.79 135.84±22.65△△ 142.64±21.53△△ 7.39 < 0.01 683.915 中型组 31 157.35±24.57** 163.52±27.94** 182.03±24.12**△△▽▽ 7.80 < 0.01 655.367 重型组 47 172.12±21.03**# 216.40±31.55**##△△ 241.59±23.47**##△△▽▽ 87.70 < 0.01 662.834 F — 40.97 68.57 150.97 — — — P — < 0.01 < 0.01 < 0.01 — — — MS组内 — 629.210 824.549 541.508 — — — q检验: 与轻型组比较*P < 0.05,**P < 0.01;与中型组比较#P < 0.05,##P < 0.01;同组与发病2 h前比较△P < 0.05, △△P < 0.01;与发病12 h前比较▽P < 0.05,▽▽P < 0.01 表 2 病人预后与血浆NT-proBNP水平关系比较(x±s;pg/mL)
分组 n 发病2 h 发病12 h 发病24 h F P MS组内 预后良好组 88 101.63±27.19 161.34±38.46△△ 175.75±32.25△△▽▽ 125.13 < 0.01 1 086.176 预后不良组 12 186.51±26.35 219.54±32.78△△ 237.45±23.54△△ 10.35 < 0.01 774.327 t — 10.18 4.99 6.39 — — — P — < 0.01 < 0.01 < 0.01 — — — q检验: 同组与发病2 h前比较△P < 0.05, △△P < 0.01;与发病12 h前比较▽P < 0.05,▽▽P < 0.01 -
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