血浆脑钠肽水平与首发急性脑梗死预后的关系

目的 探讨脑钠肽(brain natriuretic peptide,BNP)对急性脑梗死患者的预后价值.方法 纳入65例首发急性脑梗死患者和32名正常对照者.病例组神经功能缺损采用中国卒中量表(Chinese Stroke Scale,CSS)评价.血浆BNP浓度采用荧光免疫定量法检测.病例组死亡和复发性卒中事件进行随访.比较事件组与非事件组血浆BNP浓度,分析血浆BNP浓度与预后不良的关系.结果 急性腩梗死患者血浆BNP浓度为(238.7±131.6)pg/ml,显著高于健康对照组的(38.7±23.8)pg/ml(P<0.01).随访期间有9例(13.8%)患者死亡,8例(12.3%)复发非致死性卒中.死亡/复发性卒中事件组患者基线血浆BNP浓度为(304.0±134.9)pg/ml,显著高于非事件组的(214.4±120.9)pg/ml(P<0.01).血浆NBP浓度与CSS评分之间存在显著相火性(r=-0.359,P<0.05).对各种危险凶素进行多变量分析表明,BNP水平(OR=3.5,95%CI 2.1～5.8;P<0.01)、高龄(OR=4.1,95%CI 1.7～9.2;P<0.01)和CSS评分(OR=2.6,95%CI 1.6-4.3;P<0.01)均为转归不良的独立预测因素.结论 血浆BNP水平升高是急性脑梗死患者近期死亡和复发的独立预测因素.

The relationship between the plasma level of brain natriuretic peptide and prognosis in patients with first-ever acute cerebral infarction

Objective To investigate the prognostic value of plasma brain natriuretic peptide (BNP) in patients with acute cerebral infarction. Methods Sixty-five patients with first-ever acute cerebral infarction and 32 healthy controls were recruited. The neurological deficits in patients with cerebral infarction were evaluated by using Chinese Stroke Scale (CSS).Plasma BNP levels were detected by immunofluorescence technique. Death and recurrent stroke events were followed up. Plasma BNP levels were compared between an event group and a non-event group, and the relationship between plasma BNP levels and poor prognosis was analyzed.Results Plasma BNP levels in patients with acute cerebral infarction was significantly higher than those in healthy controls (238.7 ± 131.6 pg/ml vs 38.7±23.8 pg/ml, P <0.01). Nine patients (13.8%) died, and 8 (12.3%) had nonfatal recurrent stroke during the follow-up period. Compared to the non-event group, the baseline plasma BNP levels in the death/recurrent stroke event group were significantly higher (304.0 ± 134.9 pg/ml vs 214.4 ± 120.9 pg/ml,P < 0.01). There was significant correlation between plasma BNP levels and CSS scores (r = -0.359, P <0.05). After performing multivariate analysis of various risk factors, it found that BNP levels (OR = 3.5, 95 % CI 2.1 to 5.8, P < 0.01), advanced age (OR = 4.1,95% CI 1.7 to 9.2, P <0.01) and CSS scores (OR =2.6, 95% CI 1.6 to 4.3, P <0.01)were the independent predictors of poor outcome. Conclusions The increased BNP levels are the recent death and recurrent independent predictors in patients with acute cerebral infarction.