心源性脑卒中诊断中血生化标志物检查的临床应用

Diagnosis of cardioembolic stroke with plasma Biomarkers in clinical application

目的寻找较为有效可行的血生化标志物应用于脑卒中病因学诊断，从而指导临床卒中亚型（尤其是心源性卒中）的明确诊断和后续进一步治疗与预防的开展。方法收集本院神经内科2008年1月至2008年12月间因急性脑卒中住院患者的临床资料。所有患者均经脑CT、磁共振成像（MRI）、心脑血管超声及其他检查手段确诊，并经TOAST分类标准进行病因学评估鉴定。血样于患者急诊入院后24h内采样，进行如下数种血生化标志物检查：C反应蛋白（CRP），D-二聚体（D—dimer，DD），脑钠肽（BNP）（均使用ELISA法测定）。并根据检查结果分析卒中亚型诊断中上述血生化标志物的临床应用价值。结果入选71例急性缺血性脑卒中患者。与其他亚型卒中患者比较，在心源性卒中患者中，检查发现存在较高水平的BNP与DD表达（P〈0．05）。结论使用上述血生化标志物检查，可能成为急性期心源性卒中诊断的一种较为可行有效的诊断方法，并指导其他进一步诊断性检查及后续防治措施的开展。

Objective To seek a feasible strategy in etiologic diagnosis of ischemic stroke subtypes with plasma biomarkers. Methods Inpatients with acute stroke from neurology department from Jan. 2008 to Dec. 2008 were recruited. Brain CT, MRI, ultrasonography, cardiac evaluations, and other tests were done to identify an etiologic diagnosis according to TOAST classification. Blood samples were drawn on emergency department arrival（ within 24 hours）to test selected biomarkers： C-reactive protein, D-dimer and brain natriuretic peptide（BNP） （assayed by ELISA）. The results were used to examine the diagnostic value of biochemical markers to differentiate stroke etiologies （ ep. cardioembolic stroke subtype）. Results A total of 71 hospitalized patients with ischemic stroke were enrolled during the observation period. Higher levels of BNP and D-dimer were observed in patients with cardioembolic stroke than other stroke subtypes（ P 〈 0. 05 ）. Conclusion Using a combination of BNP and DD may be a feasible strategy to improve the diagnosis of cardioembolic stroke in the acute phase, thus guiding other diagnostic tests and accelerating the start of optimal secondary prevention.