急性中重度颅脑损伤患者血浆B型脑钠肽前体水平对患者CT临床特征的影响

impact of plasma B-type brain natriuretic peptide precursor levels on clinical features of CT in patients with severe traumatic brain injury

目的探讨急性中重度颅脑损伤患者血浆B型脑钠肽前体水平(BNP)对患者CT临床特征的影响,为临床辅助评估颅脑损伤病情提供参考。方法选取2013年1月—2014年8月该院收治的发病24h以内的69例急性中重度颅脑损伤患者为研究对象,所有患者入院后立即行头颅CT扫描,记录所有患者的CT临床特征表现,并行Rotterdam CT评分,同时检测患者血浆BNP水平,另外同期选取70例健康体检者为对照组做对照,分析血浆BNP水平对患者CT临床特征表现的影响。结果颅脑损伤患者血浆BNP水平明显高于对照组(P<0.05);CT检查临床特征表现中具有基底池完全闭塞、中线移位>5mm、脑室受压比值≤0.2、伴有蛛网膜下腔出血、Rotterdam CT评分>3分与血浆高水平BNP密切相关(P<0.05);在血浆BNP高分组(BNP≥179.48pg/ml)组患者CT检查临床特征表现中,基底池情况及中线移位评分、Rotterdam CT评分、蛛网膜下腔出血的发生率高于低水平组(P<0.05),而脑室受压比值及GSC评分小于低水平组(P<0.05);相关分析提示血浆BNP水平与RotterdamCT评分、中线移位、基底池情况分级呈正相关(P<0.05),而与脑室受压比值GSC评分呈负相关(P<0.05);多因素Logistic回归分析显示:血浆BNP水平(OR=2.421,P<0.05)是Rotterdam CT评分>3分的独立预测因素。结论血浆BNP水平对急性中重度颅脑损伤患者CT检查中不同临床特征表现有一定影响,并且与Rotterdam CT评分密切相关,有利于辅诊科室评估中重度颅脑损伤患者的病情严重程度并作出相应的影像学诊断。

Objective To investigate the effect of plasma B- type brain natriuretic peptide precursor（BNP） levels on clinical features of CT in patients with acute moderate to severe traumatic brain injury, and to provide reference for clinical assistant assessment of head injury condition. Methods From January 2013 to August 2014, 69 cases in author＇s hospital within 24h acute moderate to severe traumatic brain injury were selected as the study, all patients received immediately head CT scans after admission, CT clinical features recorded in all patients performance, parallel Rotterdam CT score, simultaneous detection of plasma BNP levels in patients. In addition to the same period 70 cases of healthy persons selected as the control group, the impact of plasma BNP levels in patients with clinical features of CT manifestations was analyzed. Results The plasma BNP levels in patients with traumatic brain injury was significantly higher （P〈0.05） ; CT examination showed clinical features that have basal cistern completely occluded, midline shifts over 5mm, ventricular compression ratio 40.2, accompanied by subarachnoid hemorrhage, Rotterdam CT score 〉 3 points, it was closely related with a high level of BNP in plasma （P〈0.05）. The basal cisterns and midline shift bit score, Rotterdam CT score, the incidence of subarachnoid hemorrhage were higher in （BNP≥179.48pg / ml group） than low level group （P〈0.05）, but whose ventricular compression ratio and GSC score were less than low level group （P〈0.05）. Correlation analysis showed that plasma BNP levels and Rotterdam CT score, midline shift, basal cistern case classification was positive correlated （P〈 0.05） , but with ventricular compression ratio GSC scores were negative correlated （P〈0.05）. Multivariate Logistic regression analysis showed that BNP level （OR = 2. 421, P 〈 0.05） was an independent predictors of Rotterdam CT score over 3 points. Conclusion Plasma BNP levels for CT examinations of patients with acute moderate to severe traumatic brain injury has a certain impact on the performance of different clinical characteristics, and it is closely related to the Rotterdam CT score. It can help to evaluate patients with moderate to severe traumatic brain injury and make appropriate imaging diagnostic in ancillary diagnostic departments.