Khurana Vini G, Wijdicks Eelco F M, Heublein Denise M, McClelland Robyn L, Meyer Fredric B, Piepgras David G, Burnett John C
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Neurosurgery. 2004 Jul;55(1):69-75; discussion 75-6. doi: 10.1227/01.neu.0000126877.10254.4c.
Hypovolemia after aneurysmal subarachnoid hemorrhage (SAH) may be mediated by natriuretic peptides and can further impair cerebral perfusion in dysautoregulated and vasospastic arterial territories. Dendroaspis natriuretic peptide (DNP), derived from the venom of Dendroaspis augusticeps, the Green Mamba snake, has recently been discovered in human plasma and atrial myocardium. There is no information regarding the presence or putative role of this peptide in patients with aneurysmal SAH.
A sensitive and specific DNP radioimmunoassay was performed on venous blood samples obtained on post-SAH Days 1, 3, and 7 from 10 consecutive SAH patients (cases) and randomly from 9 healthy volunteers (controls). Clinical and laboratory data, including daily serum sodium concentration and fluid balance, were collected prospectively up to 7 days after the ictus.
Increase in plasma DNP levels occurred in five (63%) of eight patients who had DNP levels measured on Days 1 and 3 (mean increase, 29%). An increase in DNP level was significantly associated with development of a negative fluid balance (P = 0.003) and hyponatremia (P = 0.008). Three (75%) of the four patients who developed cerebral vasospasm during this study experienced an increase in DNP levels from Days 1 to 3.
The present study is the first to find a significant association between elevated levels of DNP, a new member of the natriuretic peptide family, and the development of diuresis and natriuresis in patients with aneurysmal SAH. Our findings warrant further investigation by means of a large-scale, prospective, case-control study.
动脉瘤性蛛网膜下腔出血（SAH）后的血容量减少可能由利钠肽介导，并可进一步损害自主调节功能异常和血管痉挛的动脉区域的脑灌注。源自绿曼巴蛇（Dendroaspis augusticeps）毒液的树眼镜蛇利钠肽（DNP）最近在人体血浆和心房心肌中被发现。关于该肽在动脉瘤性SAH患者中的存在情况或假定作用尚无相关信息。
对10例连续的SAH患者（病例组）在SAH后第1、3和7天采集的静脉血样本以及从9名健康志愿者（对照组）中随机采集的静脉血样本进行了灵敏且特异的DNP放射免疫分析。前瞻性收集发病后长达7天的临床和实验室数据，包括每日血清钠浓度和液体平衡情况。
在第1天和第3天检测了DNP水平的8例患者中，有5例（63%）血浆DNP水平升高（平均升高29%）。DNP水平升高与负液体平衡的发生（P = 0.003）和低钠血症（P = 0.008）显著相关。在本研究中发生脑血管痉挛的4例患者中有3例（75%）从第1天到第3天DNP水平升高。
本研究首次发现利钠肽家族的新成员DNP水平升高与动脉瘤性SAH患者利尿和利钠的发生之间存在显著关联。我们的研究结果值得通过大规模、前瞻性病例对照研究进一步调查。
