Wei Weimin, Chen Yan, Lei Da, Zhang Yanan, Weng Xiuhong, Zhou Yuliang, Zhang Li
Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University Department of Neurology, Zengcheng People's Hospital (Boji-Affiliated Hospital of Sun Yat-sen University) School of Clinical Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou Veterinary medicine, Northeast Agricultural University, Haerbin, China.
Medicine (Baltimore). 2018 Aug;97(35):e12088. doi: 10.1097/MD.0000000000012088.
Plasma brain natriuretic peptide (BNP), a diagnostic marker of cardiovascular diseases, has been previously linked to cerebrovascular diseases. Our goal was to determine whether plasma BNP level is helpful for identifying high-risk individuals who are likely to present with the 3 main subtypes of cerebral small vessel diseases (CSVDs), namely, white matter lesions, lacunar infarcts, and cerebral microbleeds, on magnetic resonance imaging (MRI) in patients with hypertension.Three hundred forty-six consecutive hypertensive patients presenting at our cardiology or neurology clinic were investigated. Plasma BNP level was measured by chemiluminescent microparticle immunoassay. The presence of CSVD was assessed by 1.5-T brain MRI. Multivariate linear regression was used to determine whether individual or combined MRI-defined CSVD subtypes were associated with BNP level, after adjustment for several covariates.The mean age of patients was 69.1 ± 9.8 years, and 44.2% were female. The highest quartile BNP group was positively associated with advanced age, female sex, clinically manifesting cardiac diseases, and ischemic CSVD (white matter lesions and lacunar infarcts) and no association with cerebral microbleeds. According to multivariate linear regression, white matter lesions [β = 0.722; 95% confidence interval (95% CI), 0.624-0.819] and lacunar infarcts (β = 0.635; 95% CI, 0.508-0.762) were independently associated with BNP level, even after controlling for vascular risk factors and clinically manifesting cardiac diseases. Combined white matter lesions and lacunar infarcts were more strongly associated with BNP level than each subtype alone. With the cutoff value of 106.4 pg/mL, BNP level had a sensitivity, a specificity, and an area under the curve of 95.2%, 64.9%, and 0.799, respectively, for white matter lesions, whereas the values were 143.0 pg/mL, 81.6%, 73.5%, and 0.848, respectively, for lacunar infarcts.Plasma BNP level, which is independently correlated with individual or combined white matter lesions and lacunar infarcts, is a useful molecular marker for identifying ischemic CSVD in patients with hypertension.
血浆脑钠肽（BNP）是心血管疾病的诊断标志物，此前已被证明与脑血管疾病有关。我们的目标是确定血浆BNP水平是否有助于识别高血压患者中，磁共振成像（MRI）上可能出现脑小血管疾病（CSVD）三种主要亚型，即白质病变、腔隙性脑梗死和脑微出血的高危个体。
我们对连续就诊于我们心脏病科或神经科门诊的346例高血压患者进行了调查。采用化学发光微粒子免疫分析法测定血浆BNP水平。通过1.5-T脑MRI评估CSVD的存在情况。在调整了几个协变量后，使用多元线性回归来确定个体或联合MRI定义的CSVD亚型是否与BNP水平相关。
患者的平均年龄为69.1±9.8岁，女性占44.2%。BNP最高四分位数组与高龄、女性、临床表现为心脏病以及缺血性CSVD（白质病变和腔隙性脑梗死）呈正相关，与脑微出血无关联。根据多元线性回归分析，即使在控制了血管危险因素和临床表现为心脏病后，白质病变[β = 0.722；95%置信区间（95%CI），0.624 - 0.819]和腔隙性脑梗死（β = 0.635；95%CI，0.508 - 0.762）仍与BNP水平独立相关。白质病变和腔隙性脑梗死联合出现时与BNP水平的相关性比单独每种亚型更强。对于白质病变，BNP水平以106.4 pg/mL为临界值时，敏感性、特异性和曲线下面积分别为95.2%、64.9%和0.799，而对于腔隙性脑梗死，相应值分别为143.0 pg/mL、81.6%、73.5%和0.848。
血浆BNP水平与个体或联合的白质病变和腔隙性脑梗死独立相关，是识别高血压患者缺血性CSVD的有用分子标志物。
