急性缺血性卒中患者左心室功能的改变及其与血浆脑钠素的关系

A Study of the Effect of Acute Cerebral Infarction on Left Ventricular Function and the Relationship between Acute Cerebral Infarction and Plasma Brain Natriuretic Peptide

目的通过超声心动图进行心功能检查及血浆脑钠素（brain natriuretic peptide，BNP）测定，观察急性缺血性卒中患者心脏左心室功能（left ventricular function，LVF）的变化及其与血浆脑钠素（brain natriuretic peptide，BNP）的关系，为防治急性缺血性卒中所终心脏损害提供依据。方法选择发病24h内经临床和颅脑CT检查确诊的急性缺血性卒中患者50例作为研究对象，所有患者既往无心脏病史，并除外心功能不全、心律失常等心脏并发症。选择性别和年龄匹配的21例正常人作为对照组。以上两组均行超声心动图检查，同时抽血检测血浆BNP，对结果进行分析。结果（1）急性缺血性卒中组心脏每搏输出量（stroke volume，SV）、心输出量（cardiac output，CO）及心指数（cardiac index，CI）明显低于正常对照组（58±14vs53±12，P〈0．01；5．00±1．39vs3．87±1．55，P=0．018；1．77±0．79vs2．57±0．81，P=0．006）。（2）急性缺血性卒中组左室射血分数（left ventricular ejection fraction，LvEF）明显低于正常对照组（45±14vs68±8，P〈0．01）。（5）急性缺血性卒中组E峰最大速度／A峰最大速度（peak early diastolic velocity E Wave／peak late diastolic velocity Ewave，E／A））与正常对照组比较有统计学差异（0．97±0．j2vs1．47±0．25，P〈0．01）。（4）急性缺血性卒中组血浆BNP浓度高于正常对照组，二者比较有统计学差异（P〈0．01）。结论急性缺血性卒中可引起左心室收缩及舒张功能下降；急性缺血性卒中发病后血浆BNP浓度升高，可能主要与急性缺血性卒中本身的病理生理机制有关。

Objective To observe the changes of left ventricular function in patients with acute cerebral infarction and the relationship between acute cerebral infarction and plasma brain natriuretic peptide（BNP） by using echocardiography and determining plasma BNP concentration. It will pvoide potentile methods for preventing and treating cardiac impairment caused by acute cerebral infarction. Methods Thirty patients within 24 hours after the onset of acute cerebral infarction diagnosed by clinical manifestation and head computed tomography were enrolled. All enrolled patients had no history of heart diseases and no complications such as cardiac insufficiency and arrhythmia. And in the same period, twenty-one sex and age matched healthy persons were enrolled as control groups. All patients and conrols were undergone echocardiographic investigation and plasma determination of BNP concentration. Results （1）The mean of cardiac stroke volume（SV）, cardiac output（CO） and cardiac index（CI） in acute cerebral infarction group was much lower than those in control group（38±14 vs 53±12, P〈0.01; 3.00±1.39 vs 3.87±1.33, P〈0.05; 1.77±0.79 vs 2.37±0.81, P〈0.01, respectively）. （2）The mean of cardiac left ventricular ejection fraction（LVEF） in acute cerebral infarction group was much lower than those in control group（45±14 vs 68±8, P〈0.01）. （3）The mean of cardiac peak early diastolic velocity E wave/peak late diastolic velocity A wave （E/A ratio） in acute cerebral infarction group is lower than those in control group（0.97±0.32 vs 1.47±0.23, P〈0.01）. （4）The plasma BNP concentration in acute cerebral infarction group was higher than that in control group（P〈0.01）.Conclusion Acute cerebral infarction can induce the decrease of left ventricular systolic and diastolic function. The plasma BNP concentration increases after the onset of acute cerebral infarction, The rise of plasma BNP concentration may be caused mainly by the pathophysiologic mechanism of acute cerebral infarction.