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Neurological Surgery No Shinkei Geka Volume 40, Issue 12 （December 2012）

Neurological Surgery 脳神経外科 40巻12号（2012年12月発行）

Japanese English

研究

くも膜下出血患者における脳性ナトリウム利尿ペプチドの検討 Brain Natriuretic Peptide in Subarachnoid Hemorrhage 河村陽一郎 ¹ , 井上浩平 ² , 坂井英生 ¹ , 中島進 ¹ Yoichiro KAWAMURA ¹ , Kohei INOUE ² , Hideki SAKAI ¹ , Susumu NAKASHIMA ¹ ¹聖マリア病院脳神経外科 ²佐賀大学医学部脳神経外科 ¹Department of Neurosurgery, St-Mary Hospital ²Department of Neurosurgery, Saga University キーワード： subarachnoid hemorrhage , brain natriuretic peptide , cerebral vasospasm , delayed ischemic neurological deficit Keyword: subarachnoid hemorrhage , brain natriuretic peptide , cerebral vasospasm , delayed ischemic neurological deficit pp.1065-1070

発行日 2012年12月10日 Published Date 2012/12/10

DOI https://doi.org/10.11477/mf.1436101881

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　血中の脳性ナトリウム利尿ペプチド（brain natriuretic peptide：BNP）は心不全の重症度と相関し，生命予後の予測因子となることが知られている⁵⁾．BNPは心室のみならず視床下部でも産生され，くも膜下出血（subarachnoid hemorrhage：SAH）において高値を示すとの報告がある^1,10,15)が，依然として不明な点が多い．

　また，脳血管攣縮（cerebral vasospasm：CVS）はmortalityやmorbidityに大きく影響する²⁾．低侵襲で簡便に，かつ早期にCVSを予測または検知できる方法が望まれる．これまでもCVSとBNPとの関連についての報告^12,14)があるが，確定的ではない．

　今回，自験例を後ろ向きに評価し，SAHにおける発症時BNP測定の意義について探り，また，CVS予測因子としての有用性について検討した．

　Because of the known correlation between the brain natriuretic peptide (BNP) level and the severity of cardiac failure, cardiac function assessment often involves measuring BNP levels. In addition, BNP is produced in the hypothalamus; high BNP levels are reported in patients with subarachnoid hemorrhage (SAH), although the details of this mechanism remain to be clarified. Furthermore, there are unconfirmed reports of high BNP levels during follow up in cases of post-SAH cerebral vasospasm (CVS). In the present study, we retrospectively investigated the correlation between plasma BNP levels and severity of SAH at onset and the utility of the BNP level as a predictor for CVS.

　Of 149 SAH cases treated as inpatients at our institution between November 2008 and March 2010, our subjects comprised 28 SAH cases in which the plasma BNP level was measured at the time of hospitalization (≦48 hours after SAH onset).

　There was no significant correlation between BNP levels and SAH severity at the onset, but BNP levels tended to be high in cases accompanied by intracerebral hematoma, particularly in patients with an anterior communicating aneurysm rupture. This is thought to be the result of direct damage to the hypothalamus. The cases with normal BNP levels at the onset of SAH were apt to have favorable outcomes.

　The incidence of delayed ischemic neurological deficit (DIND) was investigated in 15 cases in which the BNP level was measured multiple times during follow up. The ratio of BNP at SAH onset compared to at days 3 to 7 of the illness was not significant; however, BNP levels tended to be high in cases with DIND complications. BNP levels may constitute a useful early marker for CVS, despite BNP susceptibility to surgical invasion and perioperative management.