NT-proBNP在心源型卒中诊断中的应用研究

目的：观察不同病因亚型缺血性卒中NT-proBNP的水平，探讨其在缺血性卒中尤其是心源型卒中中的临床意义。方法收集200例急性缺血性卒中患者的临床资料及血清NT-proBNP，根据TOAST分型标准对患者进行病因及发病机制的分型，并进行对照分析。结果200例缺血性卒中患者中心源性卒中68例，大动脉粥样硬化型99例，小动脉闭塞型22例，其他类型（包括其他原因和原因不明类型卒中）11例，心源性卒中患者NT-proBNP水平明显高于其他亚型（P=0.000），多因素分析、NT-proBNP、房颤是心源性卒中独立预测因子，ROC曲线分析显示， NT-proBNP诊断心源性卒中的曲线下面积，最佳临界值及其敏感性和特异性分别是0.914，518pg/ml，95.6%和79.0%。结论 NT-proBNP可作为急性缺血性卒中的病因诊断的生物学标志，特别是用于鉴别心源型与非心源性卒中。

Objective To observe the plasma NT-proBNP level in acute ischemic stroke patients with different etiology,and to investigate the clinical significance of differentiating specific stroke subtype,in particular cardioembolic stroke from the other ischemic stroke subtypes. Methods Consecutive 200 patients with acute ischemic stroke in a 1-year period were included. Patients were evaluated for etiology of stroke by TOAST classification. The plasma NT-proBNP level,medical history and risk factors for vascular diseases were obtained. Correlation between plasma NT-proBNP level and stroke subtype was then examined. Results 200 patients were enrolled,Atherothrombosis（99 patients）were the most frequent stroke subtype,followed by Cardioembolic（68 patients）,SAD（22 patients）,and other stroke（including SOE and SUE）（11 patients, 5.5%）.The level of plasma NT-proBNP were significantly higher in patients with cardioembolic stroke（P=0.000）. NT-proBNP levels and atrial fibrillation were independent predictors of CE stroke subtype. ROC analysis revealed that the diagnostic performance of NT-proBNP levels（area under the curve）,optimum cutoff point and its sensitivity and specificity were 0.914,518pg/mL,95.6%,and 79.0%,respectively. Conlusions NT-proBNP can be used as a biomarker to differentiate the stroke subtype,especially to distinguish CE ischemic stroke from other subtypes.