应用N末端脑钠肽前体判断颅脑创伤严重程度

Application of NT-proBNP in judging the severity of traumatic brain injury

目的:观察N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)在颅脑创伤患者早期(创伤后24 h)血浆中的浓度,探讨其在评估创伤严重程度及预后中的应用价值。方法:选择66例颅脑创伤患者,依入院时格拉斯哥昏迷评分(Glasgow coma scale,GCS)分为轻度(GCS 13~15,n=27)、中度(GCS 9~12,n=21)、重度(GCS3~8,n=18)颅脑创伤3组;检测创伤早期血浆NT-proBNP,血糖,白细胞,比较GCS评分,头部简明创伤评分(abbreviated injury score,AIS),格拉斯哥预后评分(Glasgow outcome scale,GOS)。依患者出院时GOS将其分为预后不良组(GOS 1~2,n=16)和预后良好组(GOS 3~5,n=50);比较各组NT-proBNP浓度,绘制受试者特征曲线,分析NT-proBNP对预后判断的价值及其与GCS、头部AIS评分及血糖水平、白细胞计数相关性。结果:重度组NT-proBNP浓度明显高于轻、中度组(P均<0.05),预后不良组NT-proBNP浓度明显高于预后良好组(P<0.05);NT-proBNP判断预后的最佳阈值为112 pg/mL(灵敏度0.875、特异度0.900),其与头部AIS评分、血糖水平、白细胞计数呈正相关,与GCS评分呈负相关。结论:NT-proBNP在早期颅脑创伤患者血浆中的浓度可作为评估患者严重程度和预后的参考指标。

Objective:To detect the serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level in patients with early traumatic brain injury (TBI) in order to discuss the application in evaluating the severity and prognosis.Methods:Sixty-six early TBI patients were selected in the study and divided into mild group(GCS 13-15,n =27),moderate group(GCS 9-12,n =21),severe group (GCS 3-8,n =18) according to the initial Glasgow coma score (GCS).The levels of NT-proBNP,glucose (Glu),white blood cell(WBC),GCS,head abbreviated injury score (AIS) and Glasgow outcome scale (GOS) were determined.According to the discharge GOS score,patients were divided into poor prognosis group (GOS 1-2,n =16) and good prognosis group (GOS 3-5,n =50) ; NT-proBNP concentrations from different groups were compared.The validity of NT-proBNP for predicting outcome was analyzed by receiver operating characteristic (ROC) curve.The correlation between NT-proBNP concentrations and GCS,head AIS,Glu,WBC was analyzed.Results:NT-proBNP concentration was increased significantly in the severe TBI group compared to mild and moderate TBI groups.NT-proBNP concentrations were significantly higher in the poor prognosis group than that in the good prognosis group (P ＜ 0.05).The best threshold value of NT-proBNP to predict the outcome was 112 pg/mL (sensitivity 0.875,specificity 0.900),NT-proBNP were positively correlated with head AIS,Glu,WBC,while negatively correlated GCS.Conclusion:The serum NT-proBNP levels in patients with early TBI seems to be a reference index for evaluating their severity and prognosis.