急性脑卒中患者血清氨基末端B型利钠肽前体水平的变化及其临床意义

Changes and clinical significance of serum level of NT-pro BNP in patients with acute stroke

目的 :探讨急性脑卒中(脑梗死和脑出血)患者血清氨基末端B型利钠肽前体(amino-terminal pro-B-type natriuretic peptide,NT-pro BNP)水平变化及其与疾病严重程度、预后间的关系。方法 :将急性脑卒中患者分为梗死组(73例)和出血组(46例),并设健康对照组(57名),观察梗死组和出血组患者发病24 h、第(5±2)天和第(12±2)天这3个时段的NT-pro BNP水平、梗死面积、出血量、美国国家卫生研究院卒中评分、格拉斯哥昏迷评分及发病3个月的改良Rankin评分(Modified Rankin Scale,MRS),并分析NT-pro BNP水平与疾病严重程度及发病3个月的MRS评分间的相关性。结果:梗死组患者在24 h、第(5±2)天和第(12±2)天时的NT-pro BNP水平分别为546.78 pg/m L、456.62 pg/m L和176.14 pg/m L;出血组患者分别为458.57 pg/m L、366.31 pg/m L和159.95 pg/m L。不同美国国家卫生研究院卒中评分分数亚组间的NT-pro BNP水平差异有统计学意义(P<0.01)。格拉斯哥昏迷评分与患者入院24 h时的NT-pro BNP水平显著相关(P<0.01)。血清NT-pro BNP水平越高,患者发病3个月的MRS也越高。结论:血清NTpro BNP水平可能是与脑卒中患者病情轻重及预后相关的血清生物学指标。

Objective： To investigate changes of serum level of N-terminal pro-B-type natriuretic peptide（NT-pro BNP） and its correlation with severity and prognosis of patients with acute stroke. Methods： A total of 119 patients with acute stroke were enrolled, including 73 cases of cerebral infarction（infarction group）and 46 cases of intracerebral hemorrhage（hemorrhage group）; 57 cases of healthy control were served as control group. Serum levels of NT-pro BNP after onset of stroke were measured at 24 hours,（5±2） days and（12±2） days. Assessment of infarct size or amount of bleeding,America National Institute of Health stroke scale（NIHSS）, Glasgow outcome score（GCS） and modified Rankin score（MRS） three months after onset were performed, and the correlations of NT-pro BNP level with severity of disease and modified Rankin score（MRS） three months after onset were analyzed. Results： NT-pro BNP levels of cerebral infarction patients at 24 h,（5±2） days and（12±2） days were 546.78 pg/m L, 456.62 pg/m L and 176.14 pg/m L, respectively, while that of cerebral hemorrhage patients were 458.57 pg/m L, 366.31 pg/m L and 159.95 pg/m L, respectively. The levels of NTpro BNP differed significantly between subgroups with different NIHSS scores（P〈0.01）. GCS was significantly associated with NT-pro BNP level（P〈0.01）. The higher serum level of NT-pro BNP was, the higher the MRS 3 months after onset MRS.Conclusions： Serum NT-pro BNP might be used as a biomarker for predicting the severity and prognosis of stroke patients.