血浆B型利钠肽与颅脑损伤严重程度的关系及对脑心综合征的预测价值

罗建; 许兆军

doi:10.16766/j.cnki.issn.1674-4152.002320

血浆B型利钠肽与颅脑损伤严重程度的关系及对脑心综合征的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.002320

罗建^1, ,,
许兆军²

1.
衢州市人民医院重症医学科，浙江衢州 324000
2.
宁波市第二医院急诊科，浙江宁波 315000

基金项目:

浙江省医药卫生科技计划项目 2018KY688

详细信息

通讯作者:
罗建，E-mail：luojian104@126.com

中图分类号: R651.15
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- 文章访问数: 308
- HTML全文浏览量: 144
- PDF下载量: 25
- 被引次数: 0
出版历程
- 收稿日期: 2021-02-01
- 网络出版日期: 2022-03-04

Relationship between plasma B-type natriuretic peptide and severity of craniocerebral injury and its predictive effect on cerebral heart syndrome

LUO Jian^{1
, ,},
XU Zhao-jun²

1.
Department of Critical Care Medicine, Quzhou People's Hospital, Quzhou, Zhejiang 324000, China

摘要

摘要: 目的分析血浆B型利钠肽(BNP)与颅脑损伤严重程度的关系及对脑心综合征的预测效能。方法选择衢州市人民医院2016年1月—2020年10月接诊的186例颅脑损伤患者作为研究对象，根据入院时格拉斯哥昏迷评分(GCS)分为轻型组(53例)、中型组(83例)和重型组(50例)。观察各组血浆BNP水平的变化，比较3组血浆BNP与神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)、胶质纤维酸性蛋白(GFAP)水平，使用受试者工作特征(ROC)曲线下面积(AUC)评价血浆BNP对脑心综合征的预测效能。结果颅脑损伤患者损伤后第1、3、7天的BNP水平分别为(74.75±21.54)ng/L、(123.89±51.47)ng/L、(93.00±31.28)ng/L；轻型组、中型组和重型组患者损伤后第1天，血浆BNP水平升高，第3天，达到高峰，第7天明显下降，差异有统计学意义(P＜0.05)；颅脑损伤越严重，损伤后第3天的GCS评分越低，血浆BNP、NSE、MBP和GFAP水平越高，差异有统计学意义(均P＜0.05)；经Pearson相关性分析，颅脑损伤后第3天血浆BNP、NSE、MBP和GFAP水平均与GCS评分呈负相关(均P＜0.05)；经单因素和多因素logistic回归分析，血浆BNP、NSE、MBP和GFAP均是脑心综合征的独立预测因素(均P＜0.05)；经ROC曲线分析，颅脑损伤后第3天血浆BNP预测脑心综合征的AUC为0.924。结论血浆BNP水平与颅脑损伤病情演变有关，其预测脑心综合征的效能较好，值得临床予以重视。
- 颅脑损伤 /
- B型利钠肽 /
- 严重程度 /
- 脑心综合征 /
- 预测
Abstract: Objective To analyse the relationship between plasma B-type natriuretic peptide (BNP) and the severity of craniocerebral injury and its predictive effect on cerebral heart syndrome. Methods A total of 186 patients with craniocerebral injury admitted to our hospital from January 2016 to October 2020 were selected as participants. They were divided into mild, medium and severe groups according to the Glasgow Coma Score (GCS) on admission. The changes in plasma BNP levels in each group were observed. The levels of plasma BNP, neuron-specific enolase (NSE), myelin basic protein (MBP) and glial fibrillary acidic protein (GFAP) in the three groups were compared. Area under receiver operating characteristic (ROC) curve (AUC) was used to evaluate the predictive efficacy of plasma BNP in cerebral heart syndrome. Results The BNP levels of patients with craniocerebral injury on the 1st, 3rd and 7th day after injury are (74.75±21.54)ng/L, (123.89±51.47)ng/L and (93.00±31.28)ng/L.The plasma BNP levels in mild, moderate and severe groups increased on day 1 after injury, peaked on day 3, and decreases significantly on day 7, with statistical significance(P < 0.05). The more severe the head injury was, the lower the GCS score was on the 3rd day after injury and the higher the plasma BNP, NSE, MBP and GFAP levels were; the difference was statistically significant (all P < 0.05). Pearson correlation analysis showed that the levels of BNP, NSE, MBP and GFAP negatively correlated with GCS score at the 3rd day after craniocerebral injury (all P < 0.05). Univariate and multivariate logistic regression analyses revealed that plasma BNP, NSE, MBP and GFAP were all independent predictors of cerebral heart syndrome (all P < 0.05). ROC curve analysis showed that the AUC of the 3rd day plasma BNP after craniocerebral injury was 0.924. Conclusion Plasma BNP level is related to the progression of craniocerebral injury and is effective in predicting cerebral heart syndrome. Thus, it is worthy of clinical attention.
- Craniocerebral injury /
- B-type natriuretic peptide /
- Severity /
- Cerebral heart syndrome /
- Predict

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图 1 血浆BNP、NSE、MBP、GFAP水平与GCS评分的关系散点图

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图 2 血浆BNP预测脑心综合征的ROC曲线分析

下载: 全尺寸图片幻灯片

表 1 不同程度颅脑损伤患者一般资料比较

组别	例数	性别[例(%)]		年龄(x±s，岁)	受伤距入院时间(x±s，h)
组别	例数	男性	女性	年龄(x±s，岁)	受伤距入院时间(x±s，h)
轻型组	53	30(56.60)	23(43.40)	46.53±4.37	8.79±3.42
中型组	83	48(57.83)	35(42.17)	47.38±4.91	8.64±2.83
重型组	50	27(54.00)	23(46.00)	48.41±3.65	9.08±3.62
统计量		0.187^a		2.301^b	0.290^b
P值		0.911		0.103	0.748
注：^a为χ²值，^b为F值。

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表 2 不同程度颅脑损伤患者损伤后BNP水平的变化(x±s，ng/L)

组别	例数	损伤后第1天	损伤后第3天	损伤后第7天	F值	P值
轻型组	53	35.62±7.69	59.81±10.87^cd	42.81±8.35	99.326	＜0.001
中型组	83	78.16±20.47^a	125.34±57.15^acd	100.26±39.41^a	26.488	＜0.001
重型组	50	110.58±32.15^ab	189.42±84.49^abcd	134.16±48.62^ab	23.314	＜0.001
F值		151.983	63.447	82.520
P值		＜0.001	＜0.001	＜0.001
注：与轻型组间比较，^aP＜0.05；与中型组间比较，^bP＜0.05；与损伤后第1天比较，^cP＜0.05；与损伤后第7天比较，^dP＜0.05。BNP为B型利钠肽。

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表 3 不同程度颅脑损伤患者各项生化指标比较(x±s)

组别	例数	GCS评分(分)	BNP (ng/L)	NSE (ng/mL)	MBP (μg/mL)	GFAP (pg/mL)
轻型组	53	13.56±1.49	59.81±10.87	8.71±3.62	5.71±2.59	5.84±2.37
中型组	83	10.42±1.07	125.34±57.15	24.18±8.79	26.42±8.75	22.98±8.62
重型组	50	6.31±0.88	189.42±84.49	75.92±12.56	81.46±13.37	63.14±15.48
F值		502.863	63.447	802.414	948.463	452.839
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
注：GCS评分为格拉斯哥昏迷评分；BNP为B型利钠肽；NSE为神经元特异性烯醇化酶；MBP为髓鞘碱性蛋白；GFAP为胶质纤维酸性蛋白。

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表 4 脑心综合征与非脑心综合征患者各项指标比较

组别	例数	性别[例(%)]		年龄(x±s，岁)	受伤距入院时间(x±s，h)	BNP (x±s，ng/L)	NSE (x±s，ng/mL)	MBP (x±s，μg/mL)	GFAP (x±s，pg/mL)
组别	例数	男性	女性	年龄(x±s，岁)	受伤距入院时间(x±s，h)	BNP (x±s，ng/L)	NSE (x±s，ng/mL)	MBP (x±s，μg/mL)	GFAP (x±s，pg/mL)
脑心综合征组	82	47(57.32)	35(42.68)	48.52±4.16	9.01±2.68	162.35±67.42	55.42±11.46	58.71±12.49	45.92±12.07
非脑心综合征组	104	58(55.77)	46(44.23)	47.87±5.69	8.76±3.97	96.47±30.47	16.52±6.71	16.23±5.84	14.48±5.39
统计量		0.045^a		0.868^b	0.489^b	8.885^b	28.909^b	30.704^b	23.743^b
P值		0.833		0.387	0.625	＜0.001	＜0.001	＜0.001	＜0.001
注：^a为χ²值，^b为t值。BNP为B型利钠肽；NSE为神经元特异性烯醇化酶；MBP为髓鞘碱性蛋白；GFAP为胶质纤维酸性蛋白。

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表 5 脑心综合征的独立预测因素分析

项目	B	SE	Wald χ²	P值	OR值	95% CI
BNP	0.452	0.163	12.941	＜0.001	1.469	1.181~5.635
NSE	1.946	0.785	5.458	0.041	0.841	0.030~1.199
MBP	1.369	0.615	7.643	0.026	3.936	1.186~9.114
GFAP	1.081	0.343	9.058	0.015	2.948	1.434~5.952

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