Role of brain natriuretic peptide in cerebral vasospasm
Role of brain natriuretic peptide in cerebral vasospasm
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DOI：
10.1007/s00701-003-0101-7
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发表时间：
2003-10-01
影响因子：
2.4
通讯作者：
Soustiel, JF
中科院分区：
文献类型：
--
作者：
Sviri, GE;Shik, V;Soustiel, JF
背景资料。脑利钠肽(BNP)是引起SAH患者低钠血症的一种有效的利钠因子。BNP可能通过其全身效应(减少血容量和血压)增加脑血流量减少和继发于血管痉挛的脑缺血。本研究旨在探讨SAH后12天内BNP血浆浓度与脑血管痉挛(CVS)发生的关系。根据目前的研究结果，作者提出了利钠肽在脑血管痉挛的病理生理机制中的作用假说，并对文献进行了复习。38例自发性蛛网膜下腔出血患者被纳入本研究。在SAH后4个不同时间段(第1-3、4-6、7-9、10-12天)测定血浆BNP浓度。26例(68.5%)患者有脑血管痉挛的TCD表现，14例(36.8%)患者有迟发性缺血性神经功能障碍(DIND)。在最终未发展为DIND的患者中，初始血浆脑钠素浓度显著升高(95.07+/-107.65 pg/ml vs.25.81+/-22.57pg/ml，p=0.0053)。DIND患者血浆BNP浓度在发病第1~3天至第4~6、7~9、10~12天分别升高3.69倍(P<0.05)、5.89倍(P<0.001)和4.5 4倍(P<0.001)。在无CVS或无症状CVS的患者中，BNP血浆浓度在第1-3天至第10-12天下降。重度蛛网膜下腔出血患者(Fisher‘s评分3~4分)与隐匿性或中度蛛网膜下腔出血患者(7-9/1-3天：4.37vs.0.75，p=0.015；第10-12/1-3天：3.37vs.0.3，p=0.0144)的血浆BNP浓度变化趋势相似。血浆BNP浓度在第1~3天至第7~9天的变化趋势与CVS的严重程度相关，轻度、中度和重度患者的BNP浓度分别平均升高2.01倍、3.8倍和5.44倍(P
Background. Brain natriuretic peptide (BNP) is a potent natriuretic factor responsible for hyponatremia observed in patients with SAH. Through its systemic effects (reduction of blood volume and blood pressure) BNP may augment cerebral blood flow reduction and ischemia secondary to vasospasm.The purpose of the present study was to evaluate the relationship between BNP plasma concentration during the first 12 days following SAH and the development of cerebral vasospasm (CVS). The authors propose a hypothesis for the role played by natriuretic peptides in the pathophysiology of cerebral vasospasm based on the present findings and review the literature.Methods. Thirty eight patients with spontaneous SAH were prospectively included in the present study. BNP plasma concentrations were assessed at four different time periods following SAH (day 1-3, 4-6, 7-9, 10-12). TCD evidence of CVS was found in 26 patients (68.5%), fourteen patients (36.8%) had delayed ischemic neurological deficits (DIND).Findings. Initial BNP plasma concentrations were significantly more elevated in patients who eventually did not develop DIND (95.07 +/- 107.65 pg/ml vs. 25.81 +/- 22.57 pg/ml, p = 0.0053). However, in patients with DIND, the BNP plasma concentration increased by 3.69 (p < 0.05), 5.89 (p < 0.001) and 4.54 fold (p < 0.001) between days 1-3 to days 4-6, 7-9 and 10-12 respectively (day I was regarded as the day of hemorrhage). In patients without CVS or asymptomatic CVS the BNP plasma concentration decreased between days 1-3 to day 10-12. A similar trend in BNP plasma concentration was found in patients with severe SAH (Fisher's score 3-4) as compared with patients with non visible or moderate SAH (BNP concentration ratio day 7-9/1-3: 4.37 vs. 0.75, p = 0.015; day 10-12/1-3: 3.37 vs. 0.3, p = 0.0144). The trend in BNP plasma concentration between day 1-3 to day 7-9 was found to correlate with CVS severity with an average increase of 2.01, 3.8 and 5.44 fold for mild, moderate and severe VS respectively (p