CAJ | 학술논문

目的：分析急性脑梗死患者血清N端脑钠肽前体(N-terminal pro-brain natriuretic peptide, NT-pro-BNP)的水平，探讨血NT-pro-BNP水平与急性脑梗死发病15 d内死亡的相关性。方法回顾性分析住院48 h内发病的急性脑梗死患者226例，在发病后72 h内测定各组血清NT-pro-BNP水平并进行NIHSS评分，按照发病15 d内患者预后是否死亡把入组患者分成死亡组和存活组。记录与患者发病15 d内死亡的相关危险因素，进行多因素Logistic回归分析。结果在发病15 d内死亡的急性脑梗死患者有24例(10.6%)。其房颤、心源性脑卒中、大灶梗死、NIHSS评分、年龄、血糖、血肌酐均数显著高于存活组(P＜0.001)，而左心室射血分数、白蛋白、LDL-C、总胆固醇均数明显低于存活组( P＜0.05)，血清NT-Pro-BNP中位数水平为2598.5 pg/mL，明显高于存活组190.4 pg/mL(P＜0.001)。区分死亡组与存活组血清NT-Pro-BNP水平的最佳切点值为955.2 pg/mL、灵敏度83.3%、特异度为82.2%、ROC曲线下面积为0.906。二分类多因素Logistic回归分析表明，NIHSS评分≥13[OR=56.18,95%CI=9.06～348.40, P=0.000]，Lg NT-Pro-BNP(OR=38.79,95%CI=6.52～230.95, P=0.000)，脑梗死体积(OR=8.73,95%CI=1.11～68.88, P=0.040)是脑梗死发病15 d内死亡的独立危险因素。结论血清NT-pro-BNP水平能预测急性脑梗死患者发病15 d内死亡的预后。
목적：분석급성뇌경사환자혈청N단뇌납태전체(N-terminal pro-brain natriuretic peptide, NT-pro-BNP)적수평，탐토혈NT-pro-BNP수평여급성뇌경사발병15 d내사망적상관성。방법회고성분석주원48 h내발병적급성뇌경사환자226례，재발병후72 h내측정각조혈청NT-pro-BNP수평병진행NIHSS평분，안조발병15 d내환자예후시부사망파입조환자분성사망조화존활조。기록여환자발병15 d내사망적상관위험인소，진행다인소Logistic회귀분석。결과재발병15 d내사망적급성뇌경사환자유24례(10.6%)。기방전、심원성뇌졸중、대조경사、NIHSS평분、년령、혈당、혈기항균수현저고우존활조(P＜0.001)，이좌심실사혈분수、백단백、LDL-C、총담고순균수명현저우존활조( P＜0.05)，혈청NT-Pro-BNP중위수수평위2598.5 pg/mL，명현고우존활조190.4 pg/mL(P＜0.001)。구분사망조여존활조혈청NT-Pro-BNP수평적최가절점치위955.2 pg/mL、령민도83.3%、특이도위82.2%、ROC곡선하면적위0.906。이분류다인소Logistic회귀분석표명，NIHSS평분≥13[OR=56.18,95%CI=9.06～348.40, P=0.000]，Lg NT-Pro-BNP(OR=38.79,95%CI=6.52～230.95, P=0.000)，뇌경사체적(OR=8.73,95%CI=1.11～68.88, P=0.040)시뇌경사발병15 d내사망적독립위험인소。결론혈청NT-pro-BNP수평능예측급성뇌경사환자발병15 d내사망적예후。
Objective To investigate the serum level of NT-pro-BNP in patients with acute ischemic stroke and to determine whether NT-pro-BNP levels were associated with the death within 15 days of stroke onset. Methods Two hundard twenty-six consecutive patients with acute ischemic stroke within 48 hours of onset were enrolled in this study. We measured plasma NT-pro-BNP within 72 h and recorded the NIHSS score on admission. Patients were divided into two groups: the deceased group, who died within 15 days, and the survival group. The factors associated with the death within 15 d of stroke onset were investigated by using multivariate logistic regression analysis. Results Twenty-four (10.6%) patients died with 15 days of stroke onset. The incidence of atrial fibrillation, cardioembolism and large infarc?tion, the mean ± SD of NIHSS score, age, glucose level and creatinine were significantly higher in the deceased group than in the survival group (P<0.001). On the other hand, the mean ± SD of LVEF, albumin, LDL-C, and total-cholester?ol were significantly lower in the deceased group than in the survival group(P<0.05 ). The median of the plasma NT-pro-BNP level was significantly higher in the deceased group than in the survival group (2598.5 vs. 190.4 pg/mL, P<0.001). The optimal cut-off level, sensitivity, specificity and ROC area of NT-pro-BNP levels to distinguish the de?ceased group from the survival group were 955.2 pg/mL, 83.3%and 82.2%, 0.906, respectively. Binary logistic regression analysis demonstrated that NIHSS score of ≥13 (OR=56.18, 95% CI=9.06 to 348.40, P =0.000) , plasma Lg NT-Pro-BNP level (OR=38.79, 95%CI=6.52 to 230.95, P=0.000) , and the size of infarction (OR=8.73, 95%CI=1.11~68.88, P=0.040) were independent factors associated with the death within acute phase of stroke. Conclusions The plas?ma NT-pro-BNP level can predict the death of stroke patients within 15 days of stroke onset.