N末端脑钠肽前体在早期预测恶性大脑中动脉梗死中的价值

Value of N-terminal pro-brain natriuretic peptide in early Prediction of malignant middle cerebral artery infarction

目的研究血浆N末端脑钠肽前体(NT-proBNP)在早期预测恶性大脑中动脉梗死(mMCAI)中的价值。方法连续观察入院时(发病24 h内)表现为急性完全前循环梗死(TACI)综合征的患者并采集入院时的血样,其中42例发展成mMCAI,40例为非恶性的大脑中动脉梗死(nmMCAI)。用电化学发光免疫分析法测定mMCAI组和nmMCAI组血浆NT-proBNP水平。采用受试者工作特征(ROC)曲线分析血浆NT-proBNP水平对mMCAI的早期预测价值。结果 mMCAI组、nmMCAI组入院时(发病24 h内)血浆NT-proBNP分别为(842.29±98.75)和(590.98±141.32)pg/mL,均显著高于健康人(68.79±38.52)pg/mL(P<0.001),mMCAI组血浆NT-proBNP水平显著高于nmMCAI组(P<0.001)。NT-proBNP预测mMCAI的ROC曲线下面积为(0.932±0.026)(P<0.001)。最佳截断点血浆NT-proBNP水平为723.56 pg/mL。当血浆NT-proBNP水平>723.56 pg/mL时,预测mMCAI的灵敏度为91%,特异度为78%,阳性预测值%为81%,阴性预测值为89%(P<0.001),灵敏度和特异度之和最大。结论急性TACI综合征患者发病24 h内血浆NT-proBNP水平可能早期预测其mMCAI发生。

[Objective] To study the value of plasma N-terminal pro-brain natriuretic peptide （NT- proBNP） in early prediction of malignant middle cerebral artery infarction （mMCAI）. [Methods] The consecutive patients with acute total anterior circulation infarction （TACI） syndrome at admission （with in 24 hour from onset） were observed and their blood sample for NT-proBNP were collected at admission. Of them, 42 patients developed into mMCAI, 40 patients experienced nonmalignant middle cerebral artery infarction （nmMCAI）. The plasma NT-proBNP of mMCAI group and nmMCAI group were measured with an electroehemi luminescence immunoassay. The value of plasma NT-proBNP in early Prediction of mMCAI was analysed by receiver operating characteristic （ROE） curve. [Results] At admission （with in 24 hour from onset）, the level of plasma NT-proBNP was （842.29±98.75） pg/mL in mMCAI group and （590.98±141.32） pg/mL in nmMCAI group, both were significantly higher than that in healthy people （68.79±38.52） pg/mL （P〈O.001）, the level of plasma NT-proBNP was significantly higher in mMCAI group than in nmMCAI group （P〈O.001）. The area under ROC curve for NT-proBNP to predict mMCAI was （0.932±0.026） （P〈O.001）. The level of NT-proBNP on optimal cutoff was 723.56 pg/mL. The level of plasma NT-proBNP 〉723.56 pg/mL had 91% sensitivity, 78% specificity, 81% positive predictive value, 89% negative predictive value for the prediction of mMCAI （P〈0.001）, the sum of the sensitivity plasma NT-proBNP within 24 hour syndrome. and the specificity was the largest from onset probably predicted early of all. [Conclusions] The level of mMCAI for patient with acute TACI