Tu W-J, Dong X, Zhao S-J, Yang D-G, Chen H
China Rehabilitation Research Center and School of Rehabilitation Medicine, Capital Medical University, Beijing, China.
J Neuroendocrinol. 2013 Sep;25(9):771-8. doi: 10.1111/jne.12052.
Inflammation and activation of the neuroendocrine systems comprise important aspects of stroke pathophysiology. The present study investigated whether baseline plasma brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), cortisol and copeptin levels on admission can predict short-term outcomes and mortality after acute ischaemic stroke. The study group consisted of 189 patients who had their first acute ischaemic stroke. Plasma levels of BNP, NT-proBNP, cortisol and copeptin were evaluated to determine their value with respect to predicting functional outcome and mortality within 3 months. As a result of cardiovascular and neurological investigations (including imaging techniques), lesion size, stroke subtype classification and clinical outcome after 3 months were determined. Plasma levels of BNP, NT-proBNP, cortisol and copeptin were associated with stroke severity, as well as short-term functional outcomes. After adjusting for all other significant outcome predictors, NT-proBNP, cortisol and copeptin remained as independent outcome predictors. In the receiver operating characteristic curve analysis, the biomarker panel (including BNP, NT-proBNP, cortisol and copeptin) predicted functional outcome and death within 90 days significantly more efficiently than the National Institute of Health Stroke Scale (NIHSS) or the biomarker alone. Copeptin showed a significantly greater discriminatory ability as a single biomarker compared to BNP, NT-proBNP, cortisol and NIHSS score. These results suggest that a biomarker panel may add valuable and time-sensitive prognostic information in the early evaluation of acute ischaemic stroke. This may provide a channel for interventional therapy in acute stroke.
神经内分泌系统的炎症和激活是中风病理生理学的重要方面。本研究调查了急性缺血性中风入院时的基线血浆脑钠肽（BNP）、N末端脑钠肽前体（NT-proBNP）、皮质醇和 copeptin 水平是否能够预测短期预后和死亡率。研究组由189例首次发生急性缺血性中风的患者组成。评估了BNP、NT-proBNP、皮质醇和copeptin的血浆水平，以确定它们在预测3个月内功能预后和死亡率方面的价值。通过心血管和神经学检查（包括成像技术），确定了病变大小、中风亚型分类和3个月后的临床结局。BNP、NT-proBNP、皮质醇和copeptin的血浆水平与中风严重程度以及短期功能结局相关。在对所有其他重要的预后预测因素进行校正后，NT-proBNP、皮质醇和copeptin仍然是独立的预后预测因素。在受试者工作特征曲线分析中，生物标志物组合（包括BNP、NT-proBNP、皮质醇和copeptin）在预测90天内的功能结局和死亡方面比美国国立卫生研究院卒中量表（NIHSS）或单一生物标志物更有效。与BNP, NT-proBNP, 皮质醇和NIHSS评分相比，copeptin作为单一生物标志物具有显著更高的区分能力。这些结果表明，生物标志物组合可能在急性缺血性中风的早期评估中增加有价值的和对时间敏感的预后信息。这可能为急性中风的介入治疗提供一个途径。
