急性缺血性卒中患者血浆脑钠肽水平与阵发性心房颤动的相关性研究

The relationship between brain natriuretic peptide levels and the paroxysmal atrial fibrillation in patients with acute ischemic stroke

目的探讨急性卒中患者血浆脑钠肽(BNP)水平与阵发性心房颤动(AF)之间的关系。方法对2010年10月至2011年9月符合标准的301例急性缺血性卒中患者行血浆BNP等检查,通过12导联心电图、心电监护及24 h动态心电图检查诊断阵发性AF 21例(7%,阵发性AF组)和非AF 280例(93%,非AF组)。组间比较采用t或χ2检验、秩和检验,多因素Logistic回归分析法分析缺血性卒中患者阵发性AF的相关因素。结果阵发性AF组的BNP明显高于非AF组[196.6(72.8～386.2)pg/ml比38.6(16.2～90.1)pg/ml,t=3.45,P<0.001]。多因素回归相关性分析发现NIHSS评分(OR=3.3,P=0.0006)和BNP水平(OR=6.5,P<0.0001)与急性缺血性卒中患者阵发性AF密切相关。结论在急性缺血性卒中患者中,血浆BNP水平可作为阵发性AF的预测指标。对于血浆BNP水平升高的患者可通过心电监护或24 h动态心电图等手段来提高阵发性AF的检出率,从而对此类患者制定正确的预防用药方案。

Objective To investigate the relation brain natriuretic peptide （BNP）levels and the detection rate of paroxysmal atrial fibrillation（ AF） after acute ischemic stroke. Methods Three hundred and one patients with acuce ischemic stroke were enrolled from October 2010 to November 2011. The plasma BNP level was measured on admission. Paroxysmal AF was detected in 21 patients （7%）by 12-lead ECG, continuous electrocardiographic monitoring, or 2g-hour Hoher ECG （ Paroxysmal AF group） and non-AF 280 patients（93% ,non-AF group）. The factors associated with paroxysmal AF were investigated by multivariate logistic regression analysis. Results The median BNP level of the paroxysmal AF was significantly higher than for the non-AF group[ 196. 6（72. 8-386. 2） pg/ml vs. 38.6 （ 16. 2-90. 1 ） pg/ml, t = 3.45, P 〈 0. 001 ]. Multivariate logistic regression analysis demonstrated that National Institutes of Health Stroke Scale score （ OR = 3.3, P = 0. 0006） and a plasma BNP level （ OR = 6. 5, P 〈 0. 0001 ） were independently associated with paroxysmal AF. Conclusion BNP levels can predict paroxysmal AF in patients with acute ischemic stroke. For the higher BNP levels patients, continuous ECG or 24-hour Holter ECG might have detected paroxysmal AF.