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。
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.