B型脑钠肽即时检测技术对急性缺血性脑卒中患者TOAST分型筛选价值的研究

Study on the screening value of point of care test of B-type natriuretic peptide for the TOAST typing in patients with acute ischemic stroke

目的探讨急诊室使用B型脑钠肽（BNP）即时检测技术（POCT）对急性缺血性脑卒中患者进行TOAST分型的快速筛选价值。方法入选拟诊为急性缺血性脑卒中的患者,在急诊室进行BNP POCT。入院后进一步完善检查,由神经病学专家对急性缺血性脑卒中患者进行TOAST分型：大动脉粥样硬化型（LAA）、心源性栓塞型（CE）、小动脉闭塞型（SAO）、不明原因型（SUE）和其他明确病因型（SOE）。结果入选病例172例,男81例,女91例,年龄33~97岁,平均（71.2±11.7）岁。其中LAA型67例（38.95%）,CE型45例（26.16%）,SAO型42例（24.42%）,SOE组和SUE组合计18例（10.47%）。CE组患者较其他亚型组年龄、冠心病发生率高,病情重,住院时间长,预后不良（P〈0.01）。本次研究中,BNP的平均值为（114.12±90.78）pg/m L,中位数为69.60pg/m L,CE组的BNP水平最高（P〈0.01）;其他组间的BNP差异无统计学意义（P〉0.05）。结论 BNP POCT技术可辅助用于CE组与其他TOAST各亚型组的快速鉴别与筛选。但该技术仅作为辅助诊断,急诊医师需结合患者的一般情况、临床病史、体格检查、实验室和影像学检查等,不可盲目根据BNP的单一检查结果,轻易下最终诊断。

Objective To explore the value of rapid screening value of Point of Care Test（POCT） of B-type natriuretic peptide （BNP） for the TOAST typing in patients with acute ischemic stroke inemergency room. Methods Patients diagnosed as acute ischemic stroke were selected to carry POCT of BNP in the emergency room. And the further examinations were performed after admission, and then the patients with acute ischemic stroke were classified with TOAST by neurologists： large artery atherosclerosis （LAA）, cardioembolism （CE）, small artery occlusion （SAO）, stroke of unknown cause type （SUE） and stoke of other determined cause （SOE）. Results 172 patients included 81 men and 91 women who aged from 33 to 97 years old, mean age was （71.2±11.7） years old were selected. Among them there were 67 cases of LAA type （38.95%）, 45 cases of CE type （26.16%）, SAO type of 42 cases （24.42%）, SOE type and SUE type total of 18 cases （10.47%）. Compared with other groups, patients in the CE group were elder, had a higher incidence of coronary heart disease, more serious illness, longer duration of hospitalization and poorer prognosis （P〈0.01）. In this study, the average value of BNP was （114.12±90.78）pg/mL, and median of that was 69.60pg/mL. However, BNP level of patients with CE was the highest （P〈0.01）; there was no significant difference of BNP among other groups （P 〉 0.05）. Conclusion POCT of BNP can be used for rapid identification and screening of the CE type from the other TOAST subtypes of ischemic stroke. However, emergency physicians should give diagnosis combining with the general situation of the patients, the clinical history, physical examination, laboratory and imaging examination, taken POCT only as a auxiliary diagnosis, can not easily get the final diagnosis blindly according to the test results of single BNP.