急性颅脑损伤后抵抗素和精氨酸加压素动态变化的临床研究

目的研究急性颅脑损伤后血中抵抗素和精氨酸加压素（AVP）的动态变化，探讨抵抗素和AVP与急性颅脑损伤后继发性脑水肿及其预后的关系。方法采用酶联免疫吸附法（ELISA）检测抵抗素含量，采用放射免疫法检测AVP含量，分别测定110例急性颅脑损伤住院患者伤后12h，伤后第3、5d血中抵抗素和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110例急性颅脑损伤患者伤后早期（12h内），血抵抗素和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，抵抗素和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均〈0．01）。颅脑损伤早期，血抵抗素和AVP含量与脑水肿严重程度（r=0．68，0．65，P均〈0．01）和脑水肿高峰持续时间（r=0．69，0．64，P均〈0．01）呈正相关。此外，不同GOS组之间抵抗素和AVP差异亦有统计学意义，其中预后不良组血抵抗素和AVP水平在伤后5d仍持续在较高水平，而且显著高于预后良好组和正常对照组（P〈0．05或P〈0．01）。同时急性颅脑损伤后血抵抗素和AVP的含量呈正相关（r=0．72，P〈0．01）。结论急性颅脑损伤后血抵抗素和AVP的动态变化与急性颅脑损伤预后密切相关，抵抗素和AVP参与了颅脑损伤后继发性脑水肿形成的病理生理过程。

Changes of resistin and arginine vasopressin in patients with acute brain injury

Objective To observe the changes of serum resistin and plasma arginine vasopressin (AVP) in patients with acute brain injuries,investigate the relationship of resistin and AVP with brain edema and prognosis following acute brain injury.Methods ELISA was used to measure the serum resistin level and radioimmunoassay was used to measure serial concentration of AVP in plasma in 110 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 levels of resistin and 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 resistin and AVP levels and longer persistent time of peak brain edema (P all <0.01).Resistin levels had positive correlation with severity of brain edema (r=0.68,P<0.01) and persist time of brain edema (r=0.69,P<0.01).AVP levels had positive correlation with severity of brain edema (r=0.65,P<0.01) and persist time of brain edema (r=0.64,P<0.01).Furthermore,there were significant increases of resistin and AVP levels in two GOS groups (P<0.01).The resistin and 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.There were a correlation between resistin and AVP in patients of acute brain injury (r=0.72,P<0.01).Conclusions Resistin and AVP level is closely associated with the prognosis after acute brain injury.Resistin and AVP may play a vital role in pathogenesis of brain edema after acute brain injury.