急性颅脑损伤后精氨酸加压素动态变化的临床研究  

Changes of arginine vasopressin in patients with acute brain injury

作　　者：黄卫东[1] 苏伟[1] 徐妙[1] 陆远强[1] 陈兆军 蒋挺英 

机构地区：[1]浙江大学医学院附属邵逸夫医院危重医学科,杭州310016 [2]杭州市放射免疫中心

出　　处：《中华创伤杂志》2006年第3期190-193,共4页Chinese Journal of Trauma

基　　金：浙江省科技厅资助项目(2004C33048);杭州市科技局资助项目(200433368)

摘　　要：目的研究急性颅脑损伤后血浆中精氨酸加压素(arginine vaso pressin,AVP)的动态变化,探讨AVP与急性颅脑损伤后继发性脑水肿及其预后的关系。方法用放射免疫法检测45例急性颅脑损伤住院患者伤后12h、伤后3,5d血浆中AVP含量,并结合临床表现、影像学检查及格拉斯哥预后评分(GOS)进行比较分析。结果本组45例急性颅脑损伤患者伤后早期(12h内)血浆AVP含量随着格拉斯哥昏迷评分(GCS)下降均有不同程度的升高。颅脑损伤越严重,AVP升高越明显,脑水肿程度越重,脑水肿高峰持续时间越长(P<0.01)。颅脑损伤早期血浆AVP含量与脑水肿严重程度(r=0.731,P<0.01)和脑水肿高峰持续时间(r=0.776,P<0.01)呈正相关。此外,不同GOS组之间AVP差异亦有统计学意义,其中预后不良组血浆AVP水平在伤后5d持续升高,而且显著高于预后良好组和正常对照组(P<0.05或P<0.01)。结论急性颅脑损伤后血浆中AVP的动态变化与急性颅脑损伤预后密切相关,AVP参与了颅脑损伤后继发性脑水肿形成的病理生理过程。Objective To observe the changes of plasma arginine vasopressin （AVP） in plasma and investigate the relationship of AVP with brain edema and prognosis following acute brain injury. Methods Radioimmunoassay was used to measure serial concentration of AVP in plasma in 45 patients with acute brain injuries at 12 hour and at days 3 and 5 after brain injury. The outcome was estimated in combination with clinical symptoms, imaging data and Glasgow Outcome Scale （GOS）. Results The plasma levels of AVP increased significantly within 12 hours after brain injury with reduction of GCS, which suggested the deterioration of brain injury. The severer brain injury resulted in higher AVP levels and longer persistent time of peak brain edema （P 〈 0.01 ）. AVP levels had positive correlation with severity of brain edema （ r = 0. 731, P 〈 0.01 ） and persist time of brain edema （ r = 0.776, P 〈 0.01 ）. Furthermore, there were significant increases of AVP levels in two GOS groups （P 〈 0.01 ）. The plasma AVP levels in poor outcome group persistently increased five days after brain injury and were higher than that in good outcome group and normal control group. Conclusions AVP level is closely associated with the prognosis after acute brain injury. AVP may play a vital role in pathogenesis of brain edema after acute brain injury.

关 键 词：精氨酸加压素 脑损伤 脑水肿 预后 

分 类 号：R651.15[医药卫生—外科学] R651.150.2[医药卫生—临床医学]