张煜,刘俊,刘青,罗双琪
ZHANG Yu,LIU Jun,LIU Qing,LUO Shuangqi

• 1:芜湖市第一人民医院重症医学科
• 2:皖南医学院第二附属医院神经外科

摘要(Abstract)：

目的 探讨创伤性颅脑损伤（TBI）患者血浆氨基末端脑利钠肽前体（NT-proBNP）与病情及预后的关系。方法 50例TBI患者按照术前格拉斯哥昏迷（GCS）评分分为重症组（GCS评分≤8分，n=30）和非重症组（GCS评分> 8分，n=20），重症组TBI患者再根据术后第3天头颅计算机断层扫描（CT）影像学结果分为无好转组（n=15）和好转组（n=15），收集重症组和非重症组TBI患者术前GCS评分、手术持续时间及术前急性生理与慢性健康Ⅱ（APACHEⅡ）评分等临床资料；分别于术前及术后第1、3、5天抽取所有TBI患者清晨静脉血3 mL，采用免疫电化学法检测血浆NT-pro BNP水平；收集所有TBI患者术前及术后第3天头颅CT资料，采用Marshall头颅CT分级标准判断患者病情严重程度和好转情况；采用Spearman相关分析TBI患者头颅CT严重程度与血浆NT-proBNP的关系。结果 重症组TBI患者APACHEⅡ评分、瞳孔直径大小、ICU住院时间、机械通气时间高于非重症组（P<0.05），重症组、无好转组、好转组TBI患者术前及术后第1天、第3天、第5天血浆NT-proBNP水平高于非重症组（P<0.05），好转组术后第3天及第5天血浆NT-proBNP水平低于未好转组（P<0.05）；所有TBI患者术后第3天血浆NT-proBNP水平较术后第1天升高（P<0.05），术后第5天非重症组、重症组、好转组TBI患者NT-proBNP水平均较术后第3天下降（P<0.05）；重症组患者术后好转率（50%,15/30）低于非重症组（80%,16/20），差异有统计学意义（P<0.05）；重症组和非重症组TBI患者术前、术后第3天CT严重程度比较，差异均有统计学意义（P<0.01）；所有TBI患者术前及术后第3天头颅CT严重程度与同时间点血浆NT-proBNP水平呈正相关（r_s> 0,P<0.05）。结论 血浆NT-proBNP可以作为判断TBI患者病情严重程度及预后的潜在指标。
Objective To investigate the relationship between plasma amino-terminal pro-brain natriuretic peptide(NT-proBNP) and the disease condition and prognosis in patients with traumatic brain injury(TBI).Methods According to the preoperative Glasgow Coma Scale(GCS) scores, 50 patients with TBI were divided into severe group(GCS score≤8 points,n= 30) and non-severe group(GCS score > 8 points,n= 20). The general clinical data [ preoperative GCS scores, preoperative Acute Physiology and Chronic Health Evaluation Ⅱ （APACHEⅡ） scores, etc. ] of the two TBI groups were collected. The plasma NT-pro BNP of all TBI patients was analyzed by immunoelectrochemical method within 4 hours before surgery and on the 1~(st), 3~(rd), and 5~(th) days after surgery. The head CT data of the two TBI groups before operation and on the 3~(rd) day after operation were collected, and the Marshall head CT classification was used to judge the severity of the patient's disease condition. The severe group was divided into the unimproved group(n= 15) and the improved group(n= 15)according to the results of cranial CT on the 3~(rd) postoperative day. The general data, plasma NTproBNP levels, and prognosis of patients were compared in each group, and the relationship between the severity of cranial CT and plasma NT-proBNP was analyzed by Spearman correlation coefficient.Results The APACHE Ⅱ score, pupil diameter, length of ICU stay, and duration of mechanical ventilation of the severe group were significantly higher than those in the non-severe group(P<0. 05). The levels of plasma NT-proBNP in the severe group, unimproved, and improved groups were significantly higher than those in the control group on the 1~(rd), 3~(rd),and 5~(th) days after operation(P<0. 05). The level of NT-proBNP in the improved group was lower than that in the unimproved group on the 3~(rd) and 5~(th) day after operation(P< 0. 05). The levels of plasma NT-proBNP in the all TBI patients were higher on the third postoperative day than on the first postoperative day(P< 0. 05). On the 5~(th) day after operation, the NT-proBNP level of TBI patients in the non-severe group,severe group, and improved group decreased compared with that on the 3~(rd) day after operation(P< 0. 05). The postoperative improvement rate in the severe group was 50%(15/30), lower than 80%(16/20) in the observation group(P< 0. 05). There was significant difference in the severity of CT before surgery and on the 3~(rd) day after surgery between the two groups(P< 0. 05). The CT severity of all TBI patients before and on the 3~(rd) day after surgery was positively correlated with the NT-proBNP level at the same time point(r_s> 0,P< 0. 05).Conclusion Plasma NT-proBNP can be used as a potential index to evaluate the severity and prognosis of TBI.

关键词(KeyWords)： 预后;创伤性颅脑损伤;氨基末端脑利钠肽前体;格拉斯哥评分;头颅CT;病情严重程度
prognosis;traumatic brain injury(TBI);N-terminal prohormone of brainnatriuretic peptide(NT-proBNP);glasgow coma scale(GCS);head CT;disease severity

Abstract:

Keywords:

基金项目(Foundation): 2021年度安徽省卫生健康科研项目（AHWJ2021a038）

作者(Author): 张煜,刘俊,刘青,罗双琪
ZHANG Yu,LIU Jun,LIU Qing,LUO Shuangqi

DOI: 10.19367/j.cnki.2096-8388.2022.04.013

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