血浆标志物与急性脑梗死预后的关系

Relationship between plasma biomarkers and prognosis of patients with acute cerebral infarction

目的:探讨血浆标志物水平在急性脑梗死和正常人群中的差异,并评估其与急性脑梗死的预后的关系;方法:纳入118例首发急性脑梗死患者和112名正常对照者,检测其血浆N端脑钠肽前体(NTproBNP)、D-二聚体(D-D)、同型半胱氨酸(HCY)的浓度。病例组临床神经功能损害程度采用美国国立卫生院神经功能缺损(NIHSS)评分,同时进行随访,观察各组的死亡、病残和复发性卒中事件。结果:急性脑梗死患者血浆NT-proBNP浓度明显高于对照组,差异具有统计学意义(P<0.05);病例组D-D浓度明显高于对照组,HCY浓度明显高于对照组,差异具有统计学意义(P<0.05);随访期间有11例(9.32%)死亡,15例(12.71%)病残,18例(15.25%)发生复发性卒中事件。血浆NT-proBNP、D-D、HCY与NIHSS评分之间明显正相关。多变量逻辑回归分析显示高龄、NIHSS评分、NT-proBNP、HCY均为预后不良的独立预测因素。结论:在急性脑梗死早期进行检测血浆标志物,如NT-proBNP、D-D、HCY,可以帮助判断病情的严重程度,其中NT-proBNP和HCY是预后不良的独立预测因素。

Objective.. To discuss the difference in plasma biomarkers between healthy people and patients with acute cerebral infarction, and to explore the value of plasma biomarkers in prognosis of patients with acute cerebral infarction. Methods： A total of 118 patients with first-ever acute cerebral infarction and 112 healthy controls were recruited and plama N-termi- nal pro-brain natriuretic peptide（NT-proBNP）, D-dimer（D-D） and homocysteine（HCY） were tested. The neurological deficits in patients with cerebral infarction were evaluated by using National Institutes of Health Stroke Scale（NIHSS）. Death, disable- ment and recurrent stroke events were followed up. Results： Plasma NT-proBNP levels in patients with acute cerebral infarction was significantly higher than those of healthy controls （373.4±112.3 pg/mL vs. 64.5± 21.4 pg/mL）. Plasma D-D levels was significantly higher than those in healthy controls. Plasma HCY levels was significantly higher than those in healthy con- trols. 11 patients （9. 32%） died, 15 patients （12.71%） disabled, and 18 patients（15.25%） had nonfatal recurrent stroke dur ing the follow-up period. There was significant positive correlation between plasma NT-proBNP, D-D, HCY levels and NIHSSscores. Multivariate logistic regression analysis demonstrated that advanced age, NIHSS scores, NT-proBNP and HCY level were the independent predictors of poor outcome. Conclusions： The increased plasma biomarkers, such as NT-proBNP, D-D, HCY levels can be used to judge the severity of the disease, and NT-proBNP and HCY are the independent predictors in pa- tients with acute cerebral infarction.