国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2014年
1期
33-38
,共6页
林绍鹏%解龙昌%张斌%陈晓辉
林紹鵬%解龍昌%張斌%陳曉輝
림소붕%해룡창%장빈%진효휘
卒中%脑缺血%利钠肽,脑%危险因素%生物学标记
卒中%腦缺血%利鈉肽,腦%危險因素%生物學標記
졸중%뇌결혈%리납태,뇌%위험인소%생물학표기
Stroke%Brain Ischemia%Natriuretic Peptide,Brain%Risk Factors%Biological Markers
目的 探讨血浆脑钠肽(brain natriuretic peptide,BNP)水平与急性缺血性卒中亚型和卒中严重程度的相关性.方法 连续纳入急性缺血性卒中患者,根据TOAST分型标准分为大动脉粥样硬化型(large-artery atherosclerosis,LAA)、小血管闭塞型(small-artery occlusion,SAO)和心源性栓塞型(cardioembolism,CE).采用电化学发光免疫法检测血浆BNP,OsiriX软件计算MRI图像的脑梗死体积.结果 共纳入159例急性缺血性卒中患者.与CE型组相比,LAA型和SAO型组高脂血症、心房颤动、BNP＞ 100 ng/L患者的构成比,低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDLC)和BNP水平,美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分和梗死体积存在显著性差异(P均＜0.05).多变量logistic回归分析显示,心房颤动[优势比(oddsratio,OR) 148.638,95％可信区间(confidence interval,CI)17.532～1 260.182;P＜0.001]和BNP＞100 ng/L(OR 3.490,95％ CI 1.033 ～11.789;P=0.044)为CE型缺血性卒中的独立危险因素.受试者工作特征曲线分析显示,预测CE型缺血性卒中的血浆BNP水平最佳截断值为101.4 ng/L,其敏感性、特异性、阳性预测值和阴性预测值分别为80.56％、76.42％、50.00％和93.07％.以最佳截断值为界将患者分为BNP≤101.4 ng/L组和＞101.4 ng/L组,BNP＞ 101.4 ng/L组男性(P=0.031)、高脂血症(P =0.002)和吸烟(P =0.026)患者的构成比以及总胆固醇(P=0.020)、三酰甘油(P=0.024)和LDL-C(P =0.013)水平显著性低于BNP≤101.4 ng/L组,而缺血性心脏病(P＜0.001)和心房颤动(P＜0.001)患者的构成比以及NIHSS评分(P=0.002)和梗死体积(P＜0.001)显著性高于和大于BNP≤101.4 ng/L组.Spearman秩相关分析显示,血浆BNP水平与三酰甘油(r=-0.224,P=0.004)和LDL-C(r=-0.170,P=0.032)水平呈显著性负相关,与NIHSS评分(r=0.167,P=0.044)和梗死体积(r=0.281,P＜0.001)呈显著性正相关.结论 血浆BNP水平可作为急诊早期区分CE型与非CE型缺血性卒中以及判断卒中严重程度的一种生物学标记物.
目的 探討血漿腦鈉肽(brain natriuretic peptide,BNP)水平與急性缺血性卒中亞型和卒中嚴重程度的相關性.方法 連續納入急性缺血性卒中患者,根據TOAST分型標準分為大動脈粥樣硬化型(large-artery atherosclerosis,LAA)、小血管閉塞型(small-artery occlusion,SAO)和心源性栓塞型(cardioembolism,CE).採用電化學髮光免疫法檢測血漿BNP,OsiriX軟件計算MRI圖像的腦梗死體積.結果 共納入159例急性缺血性卒中患者.與CE型組相比,LAA型和SAO型組高脂血癥、心房顫動、BNP＞ 100 ng/L患者的構成比,低密度脂蛋白膽固醇(low-density lipoprotein cholesterol,LDLC)和BNP水平,美國國立衛生研究院卒中量錶(National Institutes of Health Stroke Scale,NIHSS)評分和梗死體積存在顯著性差異(P均＜0.05).多變量logistic迴歸分析顯示,心房顫動[優勢比(oddsratio,OR) 148.638,95％可信區間(confidence interval,CI)17.532～1 260.182;P＜0.001]和BNP＞100 ng/L(OR 3.490,95％ CI 1.033 ～11.789;P=0.044)為CE型缺血性卒中的獨立危險因素.受試者工作特徵麯線分析顯示,預測CE型缺血性卒中的血漿BNP水平最佳截斷值為101.4 ng/L,其敏感性、特異性、暘性預測值和陰性預測值分彆為80.56％、76.42％、50.00％和93.07％.以最佳截斷值為界將患者分為BNP≤101.4 ng/L組和＞101.4 ng/L組,BNP＞ 101.4 ng/L組男性(P=0.031)、高脂血癥(P =0.002)和吸煙(P =0.026)患者的構成比以及總膽固醇(P=0.020)、三酰甘油(P=0.024)和LDL-C(P =0.013)水平顯著性低于BNP≤101.4 ng/L組,而缺血性心髒病(P＜0.001)和心房顫動(P＜0.001)患者的構成比以及NIHSS評分(P=0.002)和梗死體積(P＜0.001)顯著性高于和大于BNP≤101.4 ng/L組.Spearman秩相關分析顯示,血漿BNP水平與三酰甘油(r=-0.224,P=0.004)和LDL-C(r=-0.170,P=0.032)水平呈顯著性負相關,與NIHSS評分(r=0.167,P=0.044)和梗死體積(r=0.281,P＜0.001)呈顯著性正相關.結論 血漿BNP水平可作為急診早期區分CE型與非CE型缺血性卒中以及判斷卒中嚴重程度的一種生物學標記物.
목적 탐토혈장뇌납태(brain natriuretic peptide,BNP)수평여급성결혈성졸중아형화졸중엄중정도적상관성.방법 련속납입급성결혈성졸중환자,근거TOAST분형표준분위대동맥죽양경화형(large-artery atherosclerosis,LAA)、소혈관폐새형(small-artery occlusion,SAO)화심원성전새형(cardioembolism,CE).채용전화학발광면역법검측혈장BNP,OsiriX연건계산MRI도상적뇌경사체적.결과 공납입159례급성결혈성졸중환자.여CE형조상비,LAA형화SAO형조고지혈증、심방전동、BNP＞ 100 ng/L환자적구성비,저밀도지단백담고순(low-density lipoprotein cholesterol,LDLC)화BNP수평,미국국립위생연구원졸중량표(National Institutes of Health Stroke Scale,NIHSS)평분화경사체적존재현저성차이(P균＜0.05).다변량logistic회귀분석현시,심방전동[우세비(oddsratio,OR) 148.638,95％가신구간(confidence interval,CI)17.532～1 260.182;P＜0.001]화BNP＞100 ng/L(OR 3.490,95％ CI 1.033 ～11.789;P=0.044)위CE형결혈성졸중적독립위험인소.수시자공작특정곡선분석현시,예측CE형결혈성졸중적혈장BNP수평최가절단치위101.4 ng/L,기민감성、특이성、양성예측치화음성예측치분별위80.56％、76.42％、50.00％화93.07％.이최가절단치위계장환자분위BNP≤101.4 ng/L조화＞101.4 ng/L조,BNP＞ 101.4 ng/L조남성(P=0.031)、고지혈증(P =0.002)화흡연(P =0.026)환자적구성비이급총담고순(P=0.020)、삼선감유(P=0.024)화LDL-C(P =0.013)수평현저성저우BNP≤101.4 ng/L조,이결혈성심장병(P＜0.001)화심방전동(P＜0.001)환자적구성비이급NIHSS평분(P=0.002)화경사체적(P＜0.001)현저성고우화대우BNP≤101.4 ng/L조.Spearman질상관분석현시,혈장BNP수평여삼선감유(r=-0.224,P=0.004)화LDL-C(r=-0.170,P=0.032)수평정현저성부상관,여NIHSS평분(r=0.167,P=0.044)화경사체적(r=0.281,P＜0.001)정현저성정상관.결론 혈장BNP수평가작위급진조기구분CE형여비CE형결혈성졸중이급판단졸중엄중정도적일충생물학표기물.
Objective To investigate the correlations of plasma brain natriuretic peptide (BNP) levels and the subtypes and the severity of acute ischemic stroke.Methods Consecutive patients with acute ischemic stroke were enrolled in the study.They were divided into large-artery atherosclerosis (LAA),smallartery occlusion (SAO) and cardioembolism (CE) according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification.Electrochemiluminescence immunoassay was used to measure plasma BNP.OsiriX software was used to calculate the cerebral infarction volume of MRI.Results A total of 159 patients with acute ischemic stroke were enrolled.Compared to the CE group,there were significant differences in the proportions of hyperlipidemia,atrial fibrillation,BNP ＞ 100 ng/L,and in the levels of lowdensity lipoprotein cholesterol (LDL-C) and BNP,as well as in the National Institutes of Health Stroke Scale (NIHSS) score and the infarct volume in the groups of LAA and SAO (all P ＜0.05).Multivariate logistic regression analysis showed that atrial fibrillation (odds ratio [OR] 148.638,95％ confidence interval [CI]17.532-1 260.182; P ＜ 0.001) and BNP ＞ 100 ng/L (OR 3.490,95％ CI 1.033-11.789; P =0.044)were the independent risk factors for CE ischemic stroke.Receiver operating characteristic curve analysis showed that the optimal cutoff value for predicting plasma BNP level of the CE ischemic stroke was 101.4 ng/L,and its sensitivity,specificity,positive predictive value,and negative predictive values were 80.56％,76.42％,50.00％,and 93.07％,respectively.The optimal cutoff value was used as a boundary,the patients were divided into a BNP ≤ 101.4 ng/L group and a ＞ 101.4 ng/L group.The proportions of males (P=0.031),hyperlipidemia (P=0.002) and smoking (P =0.026),as well as the levels of total cholesterol (P=0.020),triglyceride (P=0.024) and LDL-C (P=0.013) were significantly lower than those in the BNP ≤ 101.4 ng/L group,while the proportions of patients with ischemic heart disease (P ＜0.001) and atrial fibrillation (P＜0.001),as well as the NIHSS score and the infarct volume were significantly higher and larger than those in the BNP ≤ 101.4 ng/L group.Spearman rank correlation analysis showed that the plasma BNP levels were significantly negatively correlated with the triglycerides (r=-0.224,P=0.004) and LDL-C (r=-0.170,P=0.032) levels,and were significantly positive correlated with the NIHSS scores (P=0.167,P=0.044) and the infarct volume (P=0.281,P＜0.001).Conclusions Plasma BNP level can be used as a biological marker for early differentiating CE from non-CE ischemic stroke,as well as identifying the severity of stroke.
