Chaudhuri Jaydip Ray, Sharma Vijay Kumar, Mridula Kandadai Rukmini, Balaraju Banda, Bandaru Venkata Chandra Sekher Srinivasarao
Department of Neurology, Yashoda Hospital Hyderabad, India.
Department of Neurology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Stroke Cerebrovasc Dis. 2015 Feb;24(2):485-91. doi: 10.1016/j.jstrokecerebrovasdis.2014.09.025. Epub 2014 Dec 16.
Brain natriuretic peptide (BNP) is believed to be a diagnostic marker for cardiovascular diseases, including atrial fibrillation (AF). Recent studies have incriminated BNP as a marker of cardioembolic stroke. We aimed at investigating association of plasma BNP levels in acute ischemic stroke subtypes and their outcome in Indian patients.
We recruited 270 acute ischemic stroke patients within 48 hours of symptom onset and compared with 110 age- and sex-matched control subjects. This study was carried out at Yashoda Hospital, Hyderabad, India between April 2011 and March 2013. Serum BNP levels were estimated in stroke patients and control subjects. Good functional outcome at 3 months was defined as modified Rankin score (mRS) 2 or less.
Elevated BNP levels was significantly more in patients with acute ischemic stroke patients 119 (44%) compared with controls 4 (3.6%; P < .0001). Among stroke subtypes, elevated BNP levels were observed in 75% of cardioembolic strokes, 45.8% of small artery disease, 43.1% of larger artery atherosclerosis, and 34.5% of stroke of undetermined etiology. On multiple logistic regression analysis, elevated BNP levels were significantly associated with acute ischemic stroke (odds ratio [OR], 13.0; 95% confidence interval [CI], 8.1-15.4). Among stroke subtypes, significant association was seen with cardioembolic stroke (OR, 3.5; 95% CI, 2.2-7.2). Elevated BNP levels were independently associated with poor outcome (OR, 3.4; 95% CI, 1.2-13.7; P < .0001) and higher mortality (OR, 3.4; 95% CI, 1.2-13.7; P < .0001).
Elevated BNP level is an independent marker for cardioembolic stroke and poor outcome at 90 days follow-up. No significant association was seen with other stroke subtypes.
脑钠肽（BNP）被认为是包括心房颤动（AF）在内的心血管疾病的诊断标志物。最近的研究将BNP认定为心源性栓塞性卒中的标志物。我们旨在调查印度急性缺血性卒中亚型患者血浆BNP水平及其预后的相关性。
我们招募了270例症状发作48小时内的急性缺血性卒中患者，并与110名年龄和性别匹配的对照者进行比较。本研究于2011年4月至2013年3月在印度海得拉巴的亚肖达医院进行。对卒中患者和对照者的血清BNP水平进行评估。3个月时良好的功能预后定义为改良Rankin量表（mRS）评分≤2分。
急性缺血性卒中患者中BNP水平升高的比例显著高于对照组，分别为119例（44%）和4例（3.6%；P <.0001）。在卒中亚型中，75%的心源性栓塞性卒中、45.8%的小动脉疾病、43.1%的大动脉粥样硬化和34.5%病因不明的卒中患者BNP水平升高。多因素logistic回归分析显示，BNP水平升高与急性缺血性卒中显著相关（比值比[OR]，13.0；95%置信区间[CI]，8.1 - 15.4）。在卒中亚型中，与心源性栓塞性卒中存在显著相关性（OR，3.5；95% CI，2.2 - 7.2）。BNP水平升高与预后不良（OR，3.4；95% CI，1.2 - 13.7；P <.0001）和较高死亡率（OR，3.4；95% CI，1.2 - 13.7；P <.0001）独立相关。
BNP水平升高是心源性栓塞性卒中和90天随访时预后不良的独立标志物。未发现与其他卒中亚型有显著相关性。
