重型颅脑外伤患者血浆DNP水平的初步研究

Pilot study of plasma DNP level in patients with severe brain trauma

目的研究重型颅脑损伤患者血浆树根眼镜蛇尿钠肽(DNP)水平的变化及其与低钠血症及水平衡之间的关系。方法收集实验组14例重型颅脑外伤患者(实验组)入院后第1、3及7天静脉血,同时检测血、尿电解质,血、尿渗透压,记24h出入量;收集8例健康志愿者(对照组)外周静脉血1次;采用放射免疫分析方法检测DNP浓度。结果实验组第1天、第3天的血浆DNP水平显著高于正常对照组血浆DNP水平(P<0.05),其中8例血浆DNP水平第3天较第1天出现增高并发生负水平衡,且有7例出现低钠血症。血浆DNP水平的增高与水平衡的发生呈极显著负相关(P<0.01),与低钠血症的发生显著相关(P<0.05)。结论重型颅脑外伤后,患者血浆DNP水平出现增高,并且伴随利钠利尿作用的增强。

Objective To investigate the changes of the dendroaspis natriuretic peptide （DNP） levels after severe brain trauma and its relations with the occurrence of hyponatremia and the fluid balance. Methods Venous blood samples were obtained from 14 patients with severe brain trauma on day 1, 3 and 7 of hospitalization and randomly from 8 healthy volunteers as controls. They were all measured by a specific and highly sensitive DNP radioimmunoassay. Clinical and laboratory data, including daily serum and urine sodium concentration, osmotic pressure and fluid balance, were obtained up to the 7th day after the trauma. Results The plasma DNP levels were higher in the patients measured both on day 1 and 3 than the controls. In 8 of the 14 patients, the plasma DNP levels increased from day 1 to day 3, and they all had negative fluid balance; 7 of them had hyponatremia. The increase in plasma DNP level was significantly correlated with the development of fluid balance （r=-0.69, P〈0.01） and hyponatremia （X^2 =4.38,P〈0.05）. Conclusion The plasma DNP levels were increased after severe brain trauma and were significantly associated both with natriuresis and diuresis occurrence.