Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (X.Z., S.Y., W.Z., M.L.).
Department of Radiology, Stanford University, CA (Y.Y.).
Stroke. 2021 Jan;52(2):537-542. doi: 10.1161/STROKEAHA.120.029593. Epub 2021 Jan 7.
We aimed to investigate the relationship between early NT-proBNP (N-terminal probrain natriuretic peptide) and all-cause death in patients receiving reperfusion therapy, including intravenous thrombolysis and endovascular thrombectomy (EVT).
This study included 1039 acute ischemic stroke patients with early NT-proBNP data at 2 hours after the beginning of alteplase infusion for those with intravenous thrombolysis only or immediately at the end of EVT for those with EVT. We performed natural log transformation for NT-proBNP (Ln(NT-proBNP)). Malignant brain edema was ascertained by using the SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study) criteria.
Median serum NT-proBNP level was 349 pg/mL (interquartile range, 89-1250 pg/mL). One hundred twenty-one (11.6%) patients died. Malignant edema was observed in 78 (7.5%) patients. Ln(NT-proBNP) was independently associated with 3-month mortality in patients with intravenous thrombolysis only (odds ratio, 1.465 [95% CI, 1.169-1.836]; =0.001) and in those receiving EVT (odds ratio, 1.563 [95% CI, 1.139-2.145]; =0.006). The elevation of Ln(NT-proBNP) was also independently associated with malignant edema in patients with intravenous thrombolysis only (odds ratio, 1.334 [95% CI, 1.020-1.745]; =0.036), and in those with EVT (odds ratio, 1.455 [95% CI, 1.057-2.003]; =0.022).
An early increase in NT-proBNP levels was related to malignant edema and stroke mortality after reperfusion therapy.
本研究旨在探讨接受再灌注治疗（包括静脉溶栓和血管内取栓）的患者早期 N 末端脑利钠肽前体（N-terminal pro-brain natriuretic peptide，NT-proBNP）与全因死亡之间的关系。
本研究纳入了 1039 例急性缺血性脑卒中患者，这些患者仅接受静脉溶栓治疗时，在开始给予阿替普酶静脉输注后 2 小时内获得早期 NT-proBNP 数据；而接受血管内取栓治疗的患者，则在取栓结束时立即获得早期 NT-proBNP 数据。我们对 NT-proBNP 进行自然对数转换（Ln(NT-proBNP)）。恶性脑水肿通过 SITS-MOST（Safe Implementation of Thrombolysis in Stroke-Monitoring Study）标准确定。
中位血清 NT-proBNP 水平为 349 pg/mL（四分位距 89-1250 pg/mL）。121 例（11.6%）患者死亡。78 例（7.5%）患者发生恶性脑水肿。仅接受静脉溶栓治疗的患者，Ln(NT-proBNP)与 3 个月死亡率独立相关（优势比 1.465 [95%置信区间 1.169-1.836]；=0.001），接受血管内取栓治疗的患者，Ln(NT-proBNP)与 3 个月死亡率也独立相关（优势比 1.563 [95%置信区间 1.139-2.145]；=0.006）。Ln(NT-proBNP)升高也与仅接受静脉溶栓治疗的患者恶性脑水肿独立相关（优势比 1.334 [95%置信区间 1.020-1.745]；=0.036），也与接受血管内取栓治疗的患者恶性脑水肿独立相关（优势比 1.455 [95%置信区间 1.057-2.003]；=0.022）。
再灌注治疗后早期 NT-proBNP 水平升高与恶性脑水肿和卒中死亡率相关。
