精氨酸加压素和血管紧张素Ⅱ在颅脑损伤早期变化的临床研究

Early changes of arginine vaso-pression and angiotension Ⅱ in patients with acute cerebral injury

目的 研究急性中、重型颅脑损伤血浆中精氨酸加压素 (AVP )和血管紧张素Ⅱ (AT-II)早期含量的变化及临床意义。 方法 用放射免疫法 (RIA)对 47例急性中、重型颅脑损伤患者 (GCS≤ 8分 2 2例 ,GCS >8分 2 5例 )、30例非颅脑损伤患者和 30例健康人的血浆中AVP和AT-II含量进行早期检测和分析。 结果 47例急性中、重型颅脑损伤早期患者血浆中AVP(5 0 .2 3± 15 .31)ng/L和AT -Ⅱ (2 48.18± 82 .47)ng/L ,显著高于非颅脑损伤组 [(30 .91± 11.48)和 (12 0 .6 7± 42 .49)ng/L ,P <0 .0 1];并显著高于健康人组 [(5 .16± 4.2 3)和 (4 3.11± 16 .39)ng/L ,P <0 .0 0 1];重型颅脑损伤组AVP(5 8.90± 18.12 )ng/L和AT -II(2 92 .13± 10 1.17)ng/L均明显高于中型颅脑损伤组 [(36 .6 8± 12 .16 )和 (2 0 1.42± 6 6 .10 )ng/L ,P <0 .0 1],并与GCS评分负相关 ;硬膜外血肿组AVP(4 5 .98± 13 .48)ng/L和AT -II (2 6 3.2 8± 80 .2 3)ng/L均明显低于硬膜下血肿脑损伤组 [(6 4.12± 15 .5 6 )和 (319.82± 10 8.11)ng/L ,P <0 .0 1]。 结论 AVP和AT -II可能参与继发性颅脑损伤的病理生理过程 ,病情越严重 ,早期血浆中AVP和AT -II含量越高。早期血浆中AVP和AT

Objective To study the changes and clinical significance of arginine vaso-pressin (AVP) and angiotensin II (AT-II) in patients with acute moderate and severe cerebral injury. Methods The early plasma concentration was checked by radioimmunoassay in 47 cases of acute moderate and severe cerebral injury, 30 cases of non-cerebral injury and 30 healthy volunteers. Results The early plasma concentrations of AVP(50.23±15.31 ng/L) and AT-Ⅱ(248.18±82.47 ng/L) in cerebral injury group were higher than those in non-cerebral injury group (AVP:30.91±11.48 ng/L and AT-Ⅱ:120.67±42.49 ng/L, P < 0.01 ). The early plasma concentrations of AVP and AT-Ⅱ in cerebral injury group were also obviously higher than those of volunteers (AVP:5.16±4.23 ng/L and AT-Ⅱ:43.11±16.39 ng/L, P <0.001). At the same time, the early plasma level of AVP(58.90±18.12 ng/L) and AT-Ⅱ (292.13±101.17 ng/L) was higher in severe cerebral injured patients than moderate cerebral injured ones (AVP:36.68±12.16 ng/L and AT-Ⅱ: 201.42±66.10 ng/L, P <0.01). The early level of AVP and AT-Ⅱ was negatively related to the GCS scales in acute cerebral injured patients. The early plasma concentration of AVP(45.98±13.48 ng/L) and AT-Ⅱ(263.28±80.23 ng/L) was lower in epidural hematoma group than subdural hematoma and cerebral injury group (AVP:64.12±15.56 ng/L and AT-Ⅱ: 319.82±108.11 ng/L, P <0.01). Conclusions AVP and AT-Ⅱ may play an important role in pathophysiologic process in the second cerebral injury. The more severe the cerebral injuryis, the higher early level of AVP and AT-Ⅱ will be. The early plasma level of AVP and AT-Ⅱ may be one of the severity indexes for cerebral injury.