Department of Endocrinology, University Hospital Basel, Basel, Switzerland.
J Am Coll Cardiol. 2010 Sep 21;56(13):1045-53. doi: 10.1016/j.jacc.2010.02.071.
The purpose of this study was to examine the prognostic value of midregional pro-atrial natriuretic peptide (MR-proANP) in patients with acute ischemic stroke.
The rapid and reliable estimation of prognosis in acute ischemic stroke is pivotal to optimize clinical care. MR-proANP, a recently described, stable fragment of the ANP precursor hormone, may be useful in this setting.
In a prospective observational study, we measured MR-proANP on admission in plasma of 362 consecutive patients presenting with acute ischemic stroke. The prognostic value of MR-proANP to predict mortality within 90 days and functional outcome (defined as a modified Rankin Scale of ≤2 or ≥3) was evaluated and compared with the National Institutes of Health Stroke Scale (NIHSS) score.
The discriminatory accuracy, calculated with the area under the curve (AUC) of the receiver operating characteristics curve, of MR-proANP to predict death was comparable to the NIHSS (AUC: 0.86 [95% confidence interval (CI): 0.82 to 0.90] and 0.85 [95% CI: 0.81 to 0.89; p = 0.7]). Combined, the accuracy significantly improved (0.92 [95% CI: 0.88 to 0.96; p < 0.01]). The AUC of MR-proANP to predict functional outcome was 0.70 (95% CI: 0.65 to 0.75), similar to the NIHSS (0.75 [95% CI: 0.70 to 0.80]; p = 0.16). The prognostic value of MR-proANP for both outcomes was independent of the NIHSS. Higher MR-proANP concentrations were found in stroke of cardioembolic etiology.
MR-proANP is a prognostic marker in the acute phase of stroke, improving the discriminatory value of the NIHSS, independently predicting post-stroke mortality and functional outcome. (The "COSMOS"-Study [Copeptin in Osmoregulation and Stress Assessment]; NCT00390962).
本研究旨在探讨中段促心房利钠肽（MR-proANP）在急性缺血性脑卒中患者中的预后价值。
快速可靠地评估急性缺血性脑卒中的预后对于优化临床治疗至关重要。MR-proANP 是一种新描述的、ANP 前体激素的稳定片段，在这种情况下可能有用。
在一项前瞻性观察性研究中，我们测量了 362 例连续出现急性缺血性脑卒中患者入院时的血浆 MR-proANP。评估并比较了 MR-proANP 预测 90 天内死亡率和功能结局（定义为改良 Rankin 量表≤2 或≥3）的预后价值，与国立卫生研究院卒中量表（NIHSS）评分进行比较。
MR-proANP 预测死亡的受试者工作特征曲线下面积（AUC）的判别准确性与 NIHSS 相当（AUC：0.86 [95%置信区间（CI）：0.82 至 0.90] 和 0.85 [95%CI：0.81 至 0.89；p = 0.7]）。联合使用时，准确性显著提高（0.92 [95%CI：0.88 至 0.96；p < 0.01]）。MR-proANP 预测功能结局的 AUC 为 0.70 [95%CI：0.65 至 0.75]，与 NIHSS 相似（0.75 [95%CI：0.70 至 0.80]；p = 0.16）。MR-proANP 对两种结局的预后价值均独立于 NIHSS。心源性栓塞性脑卒中患者的 MR-proANP 浓度较高。
MR-proANP 是脑卒中急性期的预后标志物，可提高 NIHSS 的判别价值，独立预测卒中后死亡率和功能结局。（COSMOS 研究[渗透压和应激评估中的 copeptin]；NCT00390962）。
