高原急性重症脑功能损伤血浆肾上腺髓质素和降钙素基因相关肽测定及意义

目的研究高原急性重症脑功能损伤患者血浆肾上腺髓质素(ADM)和降钙素基因相关肽(CGRP)的变化并探讨其作用及临床意义。方法测定35例高原急性重症脑功能损伤患者(脑功能损伤组)发病第12、、3天血浆ADM、CGRP水平,同时测定20例高原健康体检者(高原对照组)、20例平原健康体检者(平原对照组)血浆ADM、CGRP水平。结果脑功能损伤组患者血浆ADM、CGRP发病3天内的水平均高于高原对照组及平原对照组(P<0.05),而发病3天之间患者的ADM、CGRP水平无明显差异(P>0.05);高原对照组血浆ADM、CGRP均高于平原对照组(P<0.05)。脑功能损伤组血浆ADM与CGRP之间呈显著正相关(P<0.05),大脑中动脉收缩期流速(SV)与发病第1天血浆ADM、CGRP呈负相关(P<0.05)。死亡病例发病第1天血浆ADM、CGRP均高于非死亡病例(P<0.05)。结论ADM和CGRP参与了急性重症脑功能损伤的发生发展过程,对损伤时脑组织起代偿性保护作用;血浆ADM、CGRP值亦可间接反映脑损伤程度。

Determination of plasma adrenomedullin and calcitonin gene-related peptide in patients with acute severe brain impairment at high altitude and its significance

Objective To investigate the changes of adrenomedullin(ADM) and calcitonin gene-related peptide(CGRP)in patients with acute severe brain impairment at high altitude and to explore their role in the process of the disease and the significance.Methods Plasma concentrations of ADM and CGRP in patients at high altitude with acute severe brain impairment in the first three days after onset of the disease(BF,35cases), 20 normal controls at high altitude and 20 normal controls at plain were measured.Results Plasma concentrations of ADM and CGRP in BF group were significantly higher than those in control(P<0.05),but their concentrations in the three days were not significantly different(P>0.05).Plasma concentrations of ADM and CGRP in controls at high altitude were significantly higher than those in plain controls(P<0.05).The ADM in BF group showed a significantly positive correlation with the plasma concentration of CGRP(P<0.05).ADM and CGRP on the first day in BF group showed a significantly negative correlation with systolic flow rate of middle cerebral artery(SV,P<0.05).ADM and CGRP on the first day in the patients who died ultimately were significantly higher than those in survivors(P<0.05).Conclusion These findings suggest that ADM and CGRP may play an important role in the occurrence and development of acute severe brain impairment at high altitude and play an important protective role in this disease.The plasma ADM and CGRP levels of acute severe brain impairment can be an index for predicting the seriousness of the brain impairment.