血清N-端脑钠肽前体评估颅脑损伤预后的价值

Relationship between plasma level of N-terminal pro-brain natriuretic peptide and the prognosis in patients with traumatic brain injury

目的探讨血清N-端脑钠肽前体(NT-proBNP)在颅脑损伤预后评估中的价值。方法选取2013年2月至2015年12月收治的100例颅脑损伤作为观察组,同期健康体检者100例作为对照组;采集入院时清晨空腹静脉血检测血清NT-proBNP水平;绘制受试者工作特征(ROC)曲线判断NT-proBNP在预测颅脑损伤死亡的价值。结果观察组血清NT-proBNP水平[(140.9±53.8)pg/ml]显著地高于对照组[(32.5±19.3)pg/ml;P<0.05].。轻型、中型、重型颅脑损伤病人血清NT-proBNP水平分别为(86.2±31.5)、(145.9±47.2)、(245.9±61.3)pg/ml,两两比较均有统计学差异(P<0.05)。100例颅脑损伤中,死亡24例,病死率为24%;死亡病人血清NT-proBNP水平[(259.3±67.8)pg/ml]显著高于存活病人[(100.4±59.7)pg/ml;P<0.05]。ROC曲线分析表明NT-proBNP判定颅脑损伤死亡的最佳临界值为144.8 pg/ml,灵敏度为81.53%,特异度为91.47%。结论颅脑损伤病人血清NT-proBNP水平显著增高,与损伤程度有一定关系;血清NT-proBNP水平是有效预测颅脑损伤死亡结局的有效指标。

Objective To investigate the relationship of the plasma level of N-terminal pro-brain natriuretic peptide （NT-proBNP） with the severity and prognosis in the patients with traumatic brain injury （TBI）. Methods The fasting venous blood plasma levels of the NT-proBNP were detected by electrochemiluminescence method in 100 patients with TBI, of whom, 42 suffered from mild TBI, 37 moderate TBI and 21 severe TBI, and 100 healthy subjects from February, 2013 to December, 2015. The relationship of the plasma levels of NT-proBNP with injury severity degree and prognosis were analyzed. Results The plasma level of NT-proBNP [（140.9±53.8） pg/ml] was significantly higher in the patients with TBI than that [（32.5±19.3） pg/ml] in the healthy subjects （P〈0.05）. The plasma level of NT-proBNP [（245.9±61.3） pg/ml] in patients with severe TBI was significantly higher than that [（145.9±47.2） pg/ml] in the patients with moderate TBI （P〈0.05）, which was significantly higher than that [（86.2±31.5） pg/ml] in the patients with mild TBI （P〈0.05）. The plasma level of NT-proBNP [（259.3±67.3） pg/ml] was significantly higher in the dead patients （n=24） than that [（100.4±59.7） pg/ml] in the survival patients （P〈0.05）. The area under receiver operating characteristic curve of NT-proBNP levels predicting death of patients with TBI was AUC=0.932, 95%CI （0.814 ~ 0.971）. The best critical value of NT-proBNP determining death of patients with TBI was 144.8 pg/ml, and the corresponding sensitivity and specificity were 81.53% and 91.47% respectively. Conclusions The determination of the plasma NT-proBNP levels is very helpful to assessment of injury severity in the patients with TBI. It is suggested that the plasma level of NT-proBNP is of the important value to predicting the clinical treatment outcomes in the patients with TBI.