血浆脑钠肽在急性缺血性脑卒中患者住院病死率预测中的应用

Application of plasma brain natriuretic peptide in predicting in-hospital mortality of patients with acute ischemic stroke

目的探讨急性缺血性脑卒中患者人院时血浆脑钠肽（BNP）水平能否成为住院病死率的预测指标。方法回顾性入选175例发病24h内，且人院即行血浆BNP检测的急性缺血性脑卒中患者。人选病例分为死亡组（住院期间死亡患者）和生存组。采用多因素logistic回归分析住院死亡事件的相关因素。结果人选病例中有20例（11．4％）患者死亡，死亡组的心房颤动、心源性脑栓塞的构成比，脑卒中前使用利尿剂、洋地黄类药物的构成比，入院时美国国立卫生院神经功能缺损评分（NIHSS评分），空腹血糖、D-二聚体水平均显著高于生存组（P值均〈0．01）。死亡组的血浆BNP水平显著高于生存组[（751．5±315．9）比（224．1±111．5）ng／IL，P=0．001]，其中BNP较为可靠的预测水平（截点）为280ng／L（敏感度为74．3％，特异度为73．6％）。logistic多元回归分析提示，入院时NIHSS评分〉13分（OR=4．78，95％CI为1．55～15．47，P=0．007）和血浆BNP水平〉280ng／L（OR=4．67，95％CJ为1．28～17．09，P=0．020）为住院死亡事件的独立相关因素。结论急性缺血性脑卒中患者人院时血浆BNP水平可作为其住院死亡事件的预测因子。

Objective To investigate whether the plasma brain natriuretic peptide （BNP） level on admission can serve as a predictor of in-hospital death in patients with acute ischemic stroke. Methods We retrospectively studied 175 patients with acute ischemic stroke within 24 hours of onset;their plasma BNP levels were determined on admission. Patients were divided into two groups= the death group, who died during hospitalization, and the survival group. The factors associated with in-hospital death were investigated by multivariate logistic regression analysis. Results Twenty （11. 4%） patients died. Frequencies of atrial fibrillation, cardioembolism, the use of diuretics before ischemic stroke, the use of digitalis before ischemic stroke, National Institutes of Health Stroke Scale （NIHSS） score on admission, glucose level, and D-dimer were significantly higher in the death group than those in the survival group（ P〈0.01 ）. The mean plasma BNP level of the death group was significantly higher than that of the survival group （E751.5 ±315.91 ng/L vs. [224. 1± 111.5] ng/L, P=0. 001 ）. The optimal cut-off level, sensitivity, and specificity of BNP levels to distinguish the death group from the survival group were 280 ng/L （sensity 74. 3%, specificity 73. 6%）, respectively. Multivariate logistic regression analysis demonstrated that a NIHSS score of ~13 （odds ratio [OR] = 4.78; 95 % confidence interval[-Cl]： 1.55 to 15.47, P = 0. 007） and plasma BNP level of 〉280 ng/L （ OR = 4.67 ;95 % C1： 1.28 to 17.09, P = 0. 020） were predictors associated with in-hospital death. Conclusion The plasma BNP level on admission can be used to predict in-hospital death in patients with acute ischemic stroke. （Shanghai Med J, 2011, 34= 386-389）