关于NT-ProBNP在重型颅脑损伤中临床价值的研究

Clinical study about the value of NT-ProBNP in severe traumatic brain injury

目的研究重型颅脑损伤(TBI)患者中N末端B型利钠肽原(NT-Pro BNP)与颅内压(ICP)、低钠血症的相关性。方法选取山西医科大学第一医院神经外科自2016年3月至2017年8月收治的重型TBI患者44例,分别于入院后第2、12、24、48、72小时采全血检测NT-Pro BNP值、血钠值,并行腰椎穿刺术监测ICP,并以同期进行体检的10例健康者作为对照组。以所有时间点平均ICP=200 mm H_2O(1 mm H_2O=0.0098 k Pa)为界将研究组分为正常颅压组(ICP<200 mm H_2O 14例)和高颅压组(ICP>200 mm H_2O,24例),其中入选病例中6例患者因死亡未能到观察时间结束。所有患者均遵循Brain Trauma Foundation指南进行相应治疗措施,必要时行手术减压。将对照组、正常颅压组和高颅压组所有时间段平均NT-Pro BNP值和组内不同时间段的平均NT-Pro BNP值变化进行MannWhitney U检验,以区分组间NT-Pro BNP值差异是否具有统计学意义,明确NT-Pro BNP随时间变化的规律。结果 (1)高颅压组中NT-Pro BNP值较正常颅压组明显升高,差异具有统计学意义(P<0.05);(2)高颅压组中,NT-Pro BNP分别于伤后第12、24小时呈现两个上升高峰(P<0.05),并维持到48 h,于第72小时开始呈现下降趋势,差异具有统计学意义(P<0.05);(3)ICP与NT-Pro BNP呈正相关,相关系数=0.378,P<0.05,回归方程为ICP=0.043NT-Pro BNP+258.461;(4)正常颅压组中NTPro BNP较对照组轻度升高,差异具有统计学意义(P<0.05);(5)仅正常颅压组中1例出现低钠血症,且对症治疗后得到纠正,提示NT-Pro BNP与重型TBI后水电紊乱无相关性。结论在重型TBI患者中,并非所有患者均表现为NT-Pro BNP有意义的升高,但高颅压患者中,NT-Pro BNP与ICP呈正相关,可以据其变化间接反应ICP变化,本次试验并未得出可将NT-Pro BNP作为预测低钠血症及鉴别脑性盐耗综合征与抗利尿激素分泌异常综合征血清学标记的结论。

Objective To investigate the relationship between N-terminal Pro-B-type natriuretic peptide(NT-proBNP),Intracranial pressure and hyponatremia in severe Patients with isolated traumatic brain injury.Methods We measured serum NT-proBNP,ICP and serum sodium levels of38patients with isolated severe TBI on2ed,12th,24th,48th and72ed hour after injury,who were admitted in the Department of Emergency and Neurosurgery in our hospital from2016March to2017August.At the same time,10healthy who have a medical examination were served as control group.The samples was dividied into two groups as high ICP Group[ICP>200mmH2O(1mmH2O=0.0098kPa),n=24]and normal ICP Group(ICP<200mmH2O,n=14)based on mean ICP=200mmH2O,except6patients died within observation time.All patients were treated under the guidance of the Brain Trauma Foundation,decompressive craniectomy was applied if necessary.The mean NT-ProBNP values of all the observe time point in high ICP Group,normal ICP Group,and Control Group were progressed with Mann-Whitney U test to distinguish if there was statistical difference between groups.The mean NT-ProBNP values of all the observe time point in high ICP Group were analyzed by Mann-Whitney U test to clarify the law of NT-ProBNP with time.The same were completed in normal ICP Group.The relashion ship between NT-ProBNP values and the corresponding ICP values in high ICP Group was analysised by Peaeson regression analysis,if there is correlation,seeking regression equation,so was in normal ICP Group.Results(1)The level of NT-ProBNP in high ICP Group was significantly high than it in normal ICP Group,P<0.05;(2)In the high ICP Group,the level of NT-ProBNP shown two incresed peak respectively at12ed and24th hour,P<0.05,and kept to48th hour,then begun to decrease at72ed hour,P<0.05;(3)The relationship between NT-ProBNP and ICP is positive linear correlation,r=0.384,P<0.05,regression equation ICP=0.043NT-ProBNP+258.461;(4)Compered with Control group,NT-ProBNP in the normal ICP Group was only slightly increased,P<0.05;(5)Only one patient showed hyponatremia in normal ICP Group,and got improvement after symptomatic treatment,NT-ProBNP was not associated with hydrological disorder after severe craniocerebral injury.Conclusion Not all the rose of NT-ProBNP in severe TBI is significanct,however,the level of NT-ProBNP in high ICP Group is positive linear correlated with intracranial pressure and the level of ICP can be got indirected reflection through it.This study does not get the conclusion that NT-ProBNP can be difined as a blood marker to predicted hyponatremia and distinguish CSWS from SIADH.