NT-proBNP水平在急性缺血性脑卒中患者中的应用价值

Application value of NT proBNP level in patients with acute ischemic stroke

目的探讨心室脑钠肽前体(N-terminal pro B-type natriuretic peptide, NT-proBNP)对急性缺血性脑卒中患者病因分型及危险分层中的作用。方法前瞻性收集2014年9月-2018年9月河南省人民医院收治的急性缺血性脑卒中患者587例,急诊评估同时床旁快速检测NT-proBNP,行病因分型并比较其差异:大动脉粥样硬化(LAA)、心源性栓塞(CE)、小动脉闭塞(SAO)、其他确定病因卒中(SOE)和其他未定病因卒中(SUE)。结果最终入选患者332例,年龄(68.67±15.68)岁,男性181例(54.52%),其中LAA 119例(35.84%)、CE 85例(25.60%)、SAO 91例(27.41%)、其他37例(11.14%)。CE组患者年龄、心脏疾患、房颤、SSS评分≤25、mRS≥3均高于其他组(统计量依次为F=3.336、χ^2=35.883、校正χ^2=0.015、χ^2=74.755、χ^2=48.166,均P<0.001),其NT-proBNP[(798.81±347.39)pg/mL],明显高于LAA组[(421.55±178.74)pg/mL]、SAO组[(390.89±195.59)pg/mL]和其他型组[(442.93±184.45)pg/mL,t=17.163、20.411、15.810,均P<0.001]。区分CE与非CE组血浆NT-proBNP水平最佳界值为579.29 pg/mL,敏感性和特异性分别为76.5%和85.3%。结论 CE患者血浆NT-proBNP水平明显高于其他亚型,急性脑卒中患者NT-proBNP水平超过579.29 pg/mL,应警惕是否为CE亚型,诊疗决策时须结合临床综合评估。

Objective To investigate the role of NT-proBNP in etiology classification and risk stratification of patients with acute ischemic stroke. Methods A total of 587 patients with acute ischemic stroke admitted to Henan people’s Hospital from January 2016 to December 2018 were collected prospectively. At the same time of emergency evaluation, NT proBNP was detected quickly beside the bed, and the etiology was classified. The large-artery atherosclerosis(LAA), cardioembolism(CE), small-artery occlusion(SAO), stroke of other determined etiology(SOE) and stroke of other undetermined etiology(SUE) were compared. Results There were 332 acute ischemic stroke patients met the study criteria [mean age 68.67±15.68 years, 181(54.52%) male], including 119(35.84 %) with LAA, 85(25.60 %) with CE, 91(27.41 %) with SAO and 37(11.14 %) with SOE or SUE. The age, previous cardiac disease, atrial fibrillation, SSS score on admission ≤25 and mRS ≥3 at discharge in the CE patients were significantly higher than those in other subtypes(statistics in the order were F=3.336, χ^2=5.883, corrected χ^2=0.015, χ^2=74.755 and χ^2=48.166, all P<0.001). The NT proBNP level in CE group was(798.81±347.39) pg/mL, which was significantly higher than LAA group [(421.55±178.74) pg/mL], SAO group [(390.89±195.59) pg/mL] and other group [(442.93±184.45) pg/mL, statistics in the order were t=17.163, t=20.411 and t=15.810, all P<0.001]. The optimal cut-off value of the plasma NT proBNP between CE and non-CE were 579.29 pg/mL, the sensitivity and specificity were 76.5% and 85.3%, respectively. Conclusion The level of plasma NT-proBNP of patients with CE was significantly higher than that of other subtypes. When the level of NT proBNP exceeds 579.29 pg/mL in patients with acute stroke, we should be alert to whether it is CE subtype, and the diagnosis and treatment decision should be combined with clinical comprehensive evaluation.