脑钠肽、同型半胱氨酸测定在急性脑梗死诊治中的作用

Role of brain natridium peptide and homocysteine in the diagnosis and treatment of acute cerebral infarction

目的探讨血清脑钠肽(BNP)、同型半胱氨酸(Hcy)测定在急性脑梗死(ACI)患者临床诊治中的价值。方法采用病例对照研究,选取新余钢铁集团有限公司中心医院2021年1月至2022年6月收治的ACI患者205例为病例组,并根据其神经功能缺损评分(NIHSS)将其分为轻度组(n=98)、中度组(n=69)及重度组(n=38);另选取该院同期健康体检的健康人120例为健康组。采集所有受试者空腹静脉血,测定血清BNP、Hcy,比较病例组中不同神经功能缺损程度亚组的Hcy、BNP水平。根据患者治疗后改良Rankin量表(mRS)评分将其分为预后良好组(mRS评分≤2分,n=142)、预后不良组(mRS评分>2分,n=63),比较不同预后患者血清Hcy、BNP水平,并采用Pearson相关性分析评估病例组BNP、Hcy水平与预后评分的相关性。结果病例组血清Hcy、BNP分别为(17.21±2.67)μmol/L、(279.56±47.40)ng/L,均显著高于健康组的(6.68±1.04)μmol/L、(57.38±8.56)ng/L,差异均有统计学意义(t=-41.38、-50.83,均P<0.001)。病例组中重度组血清Hcy、BNP分别为(25.87±5.25)μmol/L、(420.19±94.36)ng/L,中度组分别为(17.63±3.95)μmol/L、(295.56±56.27)ng/L,轻度组分别为(12.35±2.24)μmol/L、(182.82±35.64)ng/L,三组差异均有统计学意义(F=197.54、248.20,均P<0.001)。预后不良组血清Hcy、BNP分别为(22.36±4.17)μmol/L、(365.19±54.82)ng/L,均显著高于预后良好组,差异均有统计学意义(t=12.35、18.40,均P<0.001)。相关性分析显示,病例组血清BNP、Hcy水平与其mRS预后评分均呈正相关(r=0.796、0.780,均P<0.001)。结论ACI患者的血清Hcy、BNP水平,能有效评估其病情严重程度,且在预测其预后方面也能起到一定的参考作用。

Objective To investigate the value of serum brain natriuretic peptide(BNP)and homocysteine(Hcy)in the clinical diagnosis and treatment of acute cerebral infarction.Methods This is a case-control study.A total of 205 patients with acute cerebral infarction admitted to Central Hospital of Xinyu Iron&Steel Group Co.,Ltd.from January 2021 to June 2022 were included in the patient group.These patients were further divided into mild(n=98),moderate(n=69),and severe(n=38)subgroups based on their National Institutes of Health Stroke Scale scores.Additionally,120 healthy individuals who underwent concurrent physical examinations were included in the healthy group.Fasting venous blood samples were collected from all participants.The serum levels of BNP and Hcy were determined,and the serum levels of Hcy and BNP in the various neurological deficit subgroups of the patient group were compared.Based on the modified Rankin Scale score,the patients were categorized into a good prognosis group(mRS score≤2,n=142)and a poor prognosis group(mRS score>2,n=63).The serum levels of Hcy and BNP were then compared between patients with different prognoses.Pearson correlation analysis was performed to assess the association between BNP and Hcy levels and the prognostic score in the patient group.Results The serum levels of Hcy and BNP in the patient group were(17.21±2.67)μmol/L and(279.56±47.40)ng/L,respectively,which were significantly higher than the(6.68±1.04)μmol/L and(57.38±8.56)ng/L in the healthy group(t=-41.38,-50.83,both P<0.001).The serum levels of Hcy and BNP in the severe subgroup were(25.87±5.25)μmol/L and(420.19±94.36)ng/L,respectively,and they were(17.63±3.95)μmol/L and(295.56±56.27)ng/L in the moderate subgroup,and(12.35±2.24)μmol/L and(182.82±35.64)ng/L,respectively,in the mild subgroup.Significant differences in serum levels of Hcy and BNP were observed among the mild,moderate,and severe subgroups(F=197.54,248.20,all P<0.001).The serum levels of Hcy and BNP in the poor prognosis group were(22.36±4.17)μmol/L and(365.19±54.82)ng/L,respectively,which were significantly higher than those in the good prognosis group(t=12.35,18.40,both P<0.001).Correlation analysis revealed that both serum BNP and Hcy levels were positively correlated with their modified Rankin Scale prognostic scores in the patient group(r=0.796,0.780,both P<0.001).Conclusion The serum levels of Hcy and BNP in patients with acute cerebral infarction can effectively assess the severity of the disease and can also serve as a valuable reference in predicting prognosis.