B型脑钠肽联合D-二聚体对心源性栓塞型脑卒中患者的快速筛选价值  

The value of using B-type natriuretic peptide and D-dimer in preliminary recognition of cardioembolic stroke patients

作　　者：吴智鑫[1] 李莹莹[1] 梁斯娜 秦锋周[1] 雷俊娜[1] 陈景利[1] 何明丰[1] 李旷怡[1] 

机构地区：[1]佛山市中医院急诊科,广东佛山528000

出　　处：《实用医学杂志》2018年第1期44-48,共5页The Journal of Practical Medicine

基　　金：广东省科技厅社会发展项目(编号:2014A020212002);广东省佛山市科技局医学类科技攻关项目(编号:2014AB00328;2015AB00354;2015AB00355);广东省佛山市科技创新平台项目(编号:2014AG10002);佛山市重点专科培育项目(编号:Fspy2-2015004);佛山市十三五高水平重点专科建设项目(编号:FSGSSPZD135025)

摘　　要：目的探讨B型脑钠肽(BNP)联合D-二聚体对心源性栓塞(CE)型脑卒中患者的快速筛选价值。方法前瞻性地入选2015年6月至2016年6月,经佛山市中医院及附属医院急诊科收治入院的急性缺血性脑卒中患者。在急诊科对患者诊疗,床边即时快速检测(POCT)患者的BNP水平,随访至出院。结果共纳入290例患者,平均年龄(68.41±12.06)岁,男性占46.2%。SAO型占42.8%;CE型占17.9%;LAA型占28.3%;SOE和SUE占11.0%。CE型患者的BNP水平明显高于其他TOAST分型。在校正有关因素后,BNP和D-二聚体是CE型的独立预测因素[BNP OR:1.044,P<0.001;D-二聚体OR:1.511,P=0.039]。结论急诊医师利用POCT技术,可辅助用于CE与其他TOAST各亚型的快速鉴别与筛选。BNP单独或联合D-二聚体对CE型患者的快速筛选价值各有优势。Objective To determine the value of using B-type natriuretic peptide （BNP） and D-dimer in preliminary recognition of cardioembolic stroke patients. Methods A mutilple-center study was conducted in Fos- ban Hospital of traditional Chinese Medicine （TCM） and its affiliated hospitals from July 2015 to July 2016. In the emergency departments （EDs）, emergency physicians prospectively assessed consecutive adult patients with acute cardioembolic stroke and measured plasma BNP by POCT platform on admission, then followed up. Stroke neurolo- gists evaluated patients＇ functional outcome at hospital discharge and also made discharge diagnosis and stroke etio- logic subtypes according to the TOAST criteria. Results In this study, 290 acute ischemic stroke patients met the study criteria [mean age （68.41 ＋ 12.06） years; 53.8% female]. Of the enrolled patients, 28.3% were diagnosed with LAA at discharge, 17.9% with CE, 42.8% with SAO, 11.0% with SOE or SUE. And the mean BNP concentra- tion was significantly higher in the CE group than that in other three subtypes （P 〈 0.001 ）. After adjustment for multiple clinical predictors like gender, age, coronary artery disease, atrial fibrillation and renal function, BNP and D-dimer were associated with CE [ BNP OR ： 1.044 （ 95% CI 1.025, 1.064） , P 〈 0.001 ; D-dimer OR ： 1.511 （95% CI 1.020,2.238 ）, P = 0.039, respectively ]. Conclusion Through POCT technique in the EDs, cardioem- bolic stroke patients can be differentiated from other TOAST subtypes. BNP with/without D-dimer has good but different corresponding diagnostic performance in preliminary recognition of eardioembolic stroke patients.

关 键 词：急性缺血性脑卒中 心源性脑卒中 床边及时检测 TOAST分型 

分 类 号：R743.3[医药卫生—神经病学与精神病学]