Department of Medicine, Cardiology Division, University of California, San Diego, CA 94114, USA.
Neurocrit Care. 2011 Aug;15(1):13-8. doi: 10.1007/s12028-011-9535-6.
Elevated levels of B-type natriuretic peptide (BNP) have been associated with cardiac dysfunction and adverse neurological outcomes after subarachnoid hemorrhage (SAH). We sought to determine whether elevated levels of BNP are independently associated with radiographic cerebral infarction after SAH.
Plasma BNP levels were measured after admission, a mean of 5.5 ± 3.0 days after SAH onset. Cerebral infarction was determined by retrospective review of computerized tomography (CT) scans. Cerebral vasospasm was confirmed by the presence of vascular narrowing on cerebral angiogram. The association between BNP and cerebral infarction was quantified using multivariable logistic regression and reverse stepwise elimination of clinical covariates. A stratified analysis was performed to quantify the association between BNP levels and infarction in patients with and without angiographic vasospasm.
BNP levels were measured from 119 subjects. The median BNP level was 105 pg/ml (interquartile range 37-275 pg/ml). In our multivariable model, the top quartile of BNP levels (≥ 276 pg/ml) were associated with an increased odds of cerebral infarction (OR 4.2, P = 0.009). The stratified analysis showed that the association between BNP and infarction was strongest in patients without angiographic vasospasm (OR 7.8, P = 0.006).
Elevated levels of BNP are strongly and independently associated with cerebral infarction, and the association is most pronounced in patients without angiographic vasospasm. These results provide further evidence that other mechanisms can contribute to infarction, and BNP may be a useful biomarker in detecting patients at risk for adverse outcomes without large vessel vasospasm.
脑钠肽（BNP）水平升高与蛛网膜下腔出血（SAH）后心功能障碍和不良神经结局相关。我们旨在确定 BNP 水平升高是否与 SAH 后放射学脑梗死独立相关。
入院后测量血浆 BNP 水平，平均在 SAH 发病后 5.5±3.0 天。通过计算机断层扫描（CT）扫描回顾性确定脑梗死。脑血管痉挛通过脑血管造影显示血管狭窄来确认。使用多变量逻辑回归和临床协变量的反向逐步消除来量化 BNP 与脑梗死之间的关联。进行分层分析以量化 BNP 水平与伴有和不伴有血管造影性血管痉挛患者梗死之间的关系。
从 119 名患者中测量了 BNP 水平。BNP 中位数为 105pg/ml（四分位距 37-275pg/ml）。在我们的多变量模型中，BNP 水平的四分位上限（≥276pg/ml）与脑梗死的发生几率增加相关（比值比 4.2，P=0.009）。分层分析显示，在没有血管造影性血管痉挛的患者中，BNP 与梗死之间的关联最强（比值比 7.8，P=0.006）。
BNP 水平升高与脑梗死强烈且独立相关，在没有血管造影性血管痉挛的患者中，这种关联最为显著。这些结果进一步证明，其他机制也可能导致梗死，而 BNP 可能是一种有用的生物标志物，可用于检测无大血管痉挛但有不良结局风险的患者。
