Yip Hon-Kan, Sun Cheuk-Kwan, Chang Li-Teh, Chen Mien-Cheng, Liou Chia-Wei
Division of Cardiology, Chang Gung Memorial Hospital, Kaohsiung, Basic Science, Nursing Department, Kaohsiung Hsien, Taiwan, ROC.
Circ J. 2006 Apr;70(4):447-52. doi: 10.1253/circj.70.447.
The association between plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and prognostic outcomes in patients after ischemic stroke remains unknown. The present study tested the hypothesis that NT-proBNP level is noticeably increased after ischemic stroke and that elevated NT-proBNP is associated with unfavorable clinical outcomes (UFCO).
Blood samples for NT-proBNP levels were collected serially and examined with sandwich immunoassay after acute ischemic stroke in 86 consecutive patients. The NT-proBNP levels were also measured in 30 healthy control volunteers and 30 at-risk control subjects. The NT-proBNP levels were significantly higher at 4 intervals after ischemic stroke than in healthy and at-risk control subjects (all p<0.001). The NT-proBNP decreased to a significantly lower level on day 21 and to a substantially lower level on day 90. Additionally, the NT-proBNP level at any of the 4 intervals was significantly higher in patients with than in patients without UFCO (defined as combined congestive heart failure > or = class 3, acute myocardial infarction, recurrent stroke or any cause of death) (all p<0.01). Multivariate analysis demonstrated that age and NIH Stroke Scale were the 2 strongest independent predictors of increased NT-proBNP levels (all p<0.01). Furthermore, increased NT-proBNP (> or = 150 pg/ml) was the strongest independent predictor of long-term (mean follow-up: 24 months) UFCO (26 patients) (all p<0.05).
The NT-proBNP level was markedly elevated after acute ischemic stroke and declined substantially thereafter. An increased NT-proBNP level was strongly and independently correlated with UFCO in patients after ischemic stroke.
缺血性脑卒中患者血浆N端前脑钠肽（NT-proBNP）水平与预后结果之间的关联尚不清楚。本研究检验了以下假设：缺血性脑卒中后NT-proBNP水平显著升高，且NT-proBNP升高与不良临床结局（UFCO）相关。
对86例急性缺血性脑卒中患者连续采集NT-proBNP水平的血样，并采用夹心免疫分析法进行检测。还对30名健康对照志愿者和30名高危对照受试者测量了NT-proBNP水平。缺血性脑卒中后4个时间点的NT-proBNP水平显著高于健康对照和高危对照受试者（所有p<0.001）。NT-proBNP在第21天显著降低，在第90天大幅降低。此外，在有UFCO（定义为合并充血性心力衰竭≥3级、急性心肌梗死、复发性脑卒中或任何死亡原因）的患者中，4个时间点中任何一个时间点的NT-proBNP水平均显著高于无UFCO的患者（所有p<0.01）。多变量分析表明，年龄和美国国立卫生研究院卒中量表是NT-proBNP水平升高的两个最强独立预测因素（所有p<0.01）。此外，NT-proBNP升高（≥150 pg/ml）是长期（平均随访：24个月）UFCO（26例患者）的最强独立预测因素（所有p<0.05）。
急性缺血性脑卒中后NT-proBNP水平显著升高，此后大幅下降。缺血性脑卒中患者NT-proBNP水平升高与UFCO密切且独立相关。
