血清NT-proBNP、cTnⅠ水平和血压变异性与急性脑梗死患者病情严重程度及预后的相关性

Correlations of serum NT-proBNP,cTnI,and blood pressure variability with the severity and prognosis of acute cerebral infarction patients

目的探讨血清N末端B型脑钠肽前体(NT-proBNP)、肌钙蛋白Ⅰ(cTnⅠ)水平和血压变异性与急性脑梗死患者病情严重程度及预后的相关性。方法队列研究。抽取2021年1月至2023年8月平顶山市第一人民医院收治的98例急性脑梗死患者作为观察组,另抽取同期98例健康体检者作为对照组。检测研究对象的NT-proBNP、cTnⅠ水平,并动态监测其24 h收缩压标准差(24hSSD)、24 h舒张压标准差(24hDSD)。比较观察组与对照组血清NT-proBNP、cTnⅠ、24hSSD、24hDSD差异。依据神经功能缺损评分(NIHSS)将98例急性脑梗死患者分为轻、中、重度三组,比较三组的血清NT-proBNP、cTnⅠ及24hSSD、24hDSD差异。所有患者随访3个月,依据MRS量表分为预后良好组与预后不良组,比较预后良好组与预后不良组血清NT-proBNP、cTnⅠ、24hSSD、24hDSD差异。采用Pearson相关性分析NT-proBNP、cTnⅠ、24hSSD、24hDSD与急性脑梗死患者预后的相关性。结果观察组血清NT-proBNP、cTnⅠ、24hSSD、24hDSD水平为(685.47±65.58)pg/mL、(2.45±0.27)ng/mL、(16.85±1.35)mmHg(1 mmHg=0.133 kPa)、(14.52±1.23)mmHg,高于对照组的(68.54±6.25)pg/mL、(0.02±0.01)ng/mL、(10.14±1.12)mmHg、(9.41±1.04)mmHg,差异有统计学意义(P<0.05)。重度组NT-proBNP、cTnⅠ、24hSSD、24hDSD水平为(1015.82±101.35)pg/mL、(3.48±0.36)ng/mL、(20.12±2.04)mmHg、(17.49±1.35)mmHg,高于中度组、轻度组,差异有统计学意义(P<0.05)。98例急性脑梗死患者随访3个月,其中预后良好70例,预后不良28例;预后不良组NT-proBNP、cTnⅠ、24hSSD、24hDSD水平为(1141.58±125.36)pg/mL、(3.57±0.41)ng/mL、(21.39±2.12)mmHg、(18.05±1.41)mmHg,高于预后良好组的(515.93±58.47)pg/mL、(2.05±0.24)ng/mL、(15.41±1.29)mmHg、(13.54±1.22)mmHg,差异有统计学意义(P<0.05)。经Pearson相关性分析显示,NT-proBNP、cTnⅠ、24hSSD、24hDSD与急性脑梗死患者预后呈负相关(r=-0.356、-0.314、-0.308、-0.327,P<0.05)。结论血清NT-proBNP、cTnⅠ及血压变异性可较好地评估急性脑梗死患者的病情严重程度,且与预后存在明显相关性,可作为指导早期治疗的重要指标。

Objective To investigate the correlations of serum N-terminal pro-B type natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI)and blood pressure variability with the severity and prognosis of acute cerebral infarction patients.Methods The cohort study was adopted in this study.A total of 98 patients with acute cerebral infarction admitted to Pingdingshan First People’s Hospital from January 2021 to August 2023 were selected as the observation group;and another 98 healthy individuals who underwent physical examinations during the same period were selected as the control group.The levels of NT-proBNP and cTnI of all study subjects were detected.The 24-hour systolic blood pressure standard deviation(24hSSD)and 24-hour diastolic blood pressure standard deviation(24hDSD)were dynamically monitored.The differences in serum NT-proBNP,cTnI,24hSSD,and 24hDSD between the observation group and the control group were compared.According to the National Institute of Health stroke scale(NIHSS)score,all the 98 patients with acute cerebral infarction were divided into three groups:mild group,moderate group,and severe group.The differences in levels of serum NT-proBNP,cTnI,24hSSD,and 24hDSD among the mild group,the moderate group,and the severe group were analyzed.All patients were followed up for 3 months,and they were divided into a good prognosis group and a poor prognosis group based on the modified Rankin Scale(MRS)scale.The differences in levels of serum NT-proBNP,cTnI,24hSSD,and 24hDSD between the good prognosis group and the poor prognosis group were compared.Pearson correlation analysis was used to analyze the correlations of NT-proBNP,cTnI,24hSSD,and 24hDSD with prognosis of acute cerebral infarction.Results The levels of serum NT-proBNP,cTnI,24hSSD,and 24hDSD in the observation group were(685.47±65.58)pg/mL,(2.45±0.27)ng/mL,(16.85±1.35)mmHg,1 mmHg=0.133 kPa,and(14.52±1.23)mmHg,respectively,which were higher than the(68.54±6.25)pg/mL,(0.02±0.01)ng/mL,(10.14±1.12)mmHg,and(9.41±1.04)mmHg in the control group(P<0.05).The levels of NT-proBNP,cTnI,24h SSD,and 24h DSD in the severe group were(1015.82±101.35)pg/mL,(3.48±0.36)ng/mL,(20.12±2.04)mmHg,and(17.49±1.35)mmHg,respectively,which were higher than those in the moderate group and the mild group(P<0.05).All the 98 patients with acute cerebral infarction were followed up for 3 months,including 70 cases with good prognoses and 28 cases with poor prognoses.The levels of NT-proBNP,cTnI,24hSSD,and 24hDSD in the poor prognosis group were(1141.58±125.36)pg/mL,(3.57±0.41)ng/mL,(21.39±2.12)mmHg,and(18.05±1.41)mmHg,which were higher than the(515.93±58.47)pg/mL,(2.05±0.24)ng/mL,(15.41±1.29)mmHg,and(13.54±1.22)mmHg in the good prognosis group(P<0.05).Pearson correlation analysis revealed that NT-proBNP,cTnI,24hSSD,24hDSD were negatively correlated with the prognosis of patients with acute cerebral infarction(r=-0.356,-0.314,-0.308,-0.327;P<0.05).Conclusions Serum NT-proBNP,cTnI,and blood pressure variability can effectively evaluate the severity of acute cerebral infarction,and they have significant correlations with prognosis.They may serve as important indicators to guide early treatment.