急性颅脑损伤早期内皮素和一氧化氮含量变化的临床研究

目的研究急性中、重型颅脑损伤患者早期血浆内皮素(ET)和一氧化氮(NO)含量的变化及其临床意义。方法用放射免疫法(RIA）和Green法对48例急性中、重型颅脑损伤患者［格拉斯哥昏迷评分(GCS)>8分21例，≤8分27例］和42例非颅脑损伤患者早期（伤后1d）及恢复期（伤后14d）血浆中ET和NO含量进行检测和分析，同时测定38例正常人血浆中ET和NO含量。结果48例急性颅脑损伤患者早期血浆中ET［（109.73±12.61)ng/L］和NO［(92.82±18.21)μmol/L］均显著高于非颅脑损伤患者［(67.90±11.33)ng/L和(52.66±12.82)μmol/L，P<0.01］;并显著高于正常人［(50.65±17.12)ng/L和(36.12±12.16)μmol/L，P<0.001］。重型颅脑损伤患者ET［(116.18±18.12)ng/L］和NO［(108.19±13.28)μmol/L］均显著高于中型颅脑损伤患者［(92.33±16.32)ng/L和(76.38±12.71)μmol/L，P<0.01］,与GCS分值呈负相关；硬膜下血肿、脑损伤患者ET［(126.23±15.23)ng/L］和NO［(118.18±10.12)μmol/L］均显著高于硬膜外血肿患者［(81.13±12.37)ng/L和(68.02±13.18)μmol/L，P<0.01］。而恢复期颅脑损伤组和非颅脑损伤组血浆ET和NO含量均明显下降，接近正常对照组(P>0.05)。结论ET和NO参与了急性颅脑损伤早期的病理生理过程，病情越重，ET和NO的血浆浓度越高。血浆中ET和NO水平的变化可作为早期判断颅脑损伤严重程度的重要指标。

Early changes of endothelin and nitric oxide in patients with acute brain injury

Objective　To investigate the early changes and clinical significance of plasma endothelin(ET) and nitric oxide(NO) in patients with acute brain injury.　Methods　The plasma ET and NO concentration at 1 day after injury were checked with radioimmunoassay and Green method in 48 cases of acute brain injury, in 42 cases of non-brain injury and in 38 healthy volunteers. 　Results　 The early plasma concentrations of ET and NO were (109.73±12.61) ng/Lf and (92.82±18.21) μmol/L, respectively, in 48 cases of acute cerebral injury, which were higher than those in the non-brain injury group［(67.90±11.33) ng/L and (52.66±12.82) μmol/L, respectively, P<0.01］ and in the normal control group ［(50.65±17.12)ng/L and (36.12±12.16) μmol/L, respectively, P<0.001］. The amounts of ET and NO in the patients with severe brain injury were (116.18±18.12) ng/L and (108.19±13.28) μmol/L, respectively, which were significantly higher than that of the moderate brain injury group［(92.33±16.32) ng/L and (76.38±12.71) μmol/L, respectively, P<0.01］.The early levels of ET and NO were negatively related to the GCS scores of the patients with acute brain injury. The amounts of ET and NO were (126.23±15.23)ng/l and (118.18±10.12) μmol/L, respectively, in the patients with subdural hematomas, which were significantly higher than those in the patients with epidural hematomas ［(81.13±12.37) ng/L and(68.02±13.18) μmol/L, respectively, P<0.01］. The stable plasma concentrations of ET and NO at 14 days after injury in the patients with acute brain injury and with non-brain injury were similar to that in the normal controls. 　Conclusions　 ET and NO are related to the pathophysiological process in the early period of acute brain injury, and the values of ET and NO correlate positively with the clinical manifestations. The changes of plasma ET and NO can be regarded as important indexes to diagnose the severity of acute brain injury.