B型钠尿肽对心房颤动合并脑梗死急性期抗栓治疗选择的意义  

Significance of B-typenatriuretic peptide in choice of antithrombotic therapy for acute cerebral infarction patients with atrial fibrillation

作　　者：刘帮健[1] 曲忠森[1] 赵玉武[1] 孙晓江[1] 杨嘉君[1] LIU Bang-jian;QU Zhong-sen;ZHAO Yu-wu;SUN Xiao-jiang;YANG Jia-jun(Department of Neurology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China)

机构地区：[1]上海交通大学附属第六人民医院神经内科,上海200233

出　　处：《上海交通大学学报（医学版）》2017年第1期85-88,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的·探讨B型钠尿肽(BNP)对心房颤动合并脑梗死急性期抗栓治疗选择的意义。方法·回顾性分析714例急性脑梗死合并心房颤动患者的临床资料。以BNP=912.5 pg/m L(第95分位数)为分界值,将患者分成2组,每组再根据不同的抗栓治疗,分为抗血小板组和抗凝组。比较入院时和治疗后21 d 2组患者的美国国立卫生研究院卒中量表(NIHSS)评分和改良的Rankin量表(m RS)评分,同时比较2组颅内出血、症状性颅内出血、消化道出血、脑梗死再发、深静脉血栓发生率及病死率。结果·对于BNP>912.5 pg/m L的患者,抗凝治疗组的NIHSS评分(P=0.015)及m RS评分(P=0.031)改善比显著高于抗血小板治疗组;抗血小板治疗组病死率和脑梗死再发率高于抗凝治疗组,但差异无统计学意义;两治疗组所有出血、颅内出血、症状性颅内出血、消化道出血、深静脉血栓发生率比较,差异无统计学意义。对于BNP≤912.5 pg/m L的患者,两治疗组之间NIHSS评分及m RS评分改善比的差异无统计学意义;抗血小板治疗组病死率和脑梗死再发率高于抗凝治疗组,但差异无统计学意义;两治疗组所有出血、颅内出血、症状性颅内出血、消化道出血、深静脉血栓发生率比较,差异无统计学意义。结论·BNP>912.5 pg/m L的心房颤动合并脑梗死急性期患者采用抗凝治疗,其疗效可能优于抗血小板治疗。Objective·To evaluate the significance of B-type natriuretic peptide(BNP)in choice of antithrombotic therapy for acute cerebral infarctionpatients with atrial fibrillation.Methods·Clinical data of714acute cerebral infarction patients with atrial fibrillation were retrospectively analyzed.The patients were divided into two groups according to the cut-off value of BNP(912.5pg/mL,the95th quantile).Each group was subdivided intoantiplatelet group and anticoagulant group.National Institute of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS)scores of patients atadmission and day21after treatment were compared,and the incidence rates of complication,such as intracranial hemorrhage,symptomatic intracranialhemorrhage,gastrointestinal bleeding,recurrent infarction,deep vein thrombosis,and the mortality were also compared.Results·In BNP>912.5pg/mLgroup,the improved rates of NIHSS(P=0.015)and mRS(P=0.031)of anticoagulant group were higher than those of antiplatelet group.The mortalityand the incidence of cerebral infarction recurrence in antiplatelet group were higher than those in anticoagulant group,with no statistical significance.Theincidences of all kinds of bleeding,intracranial hemorrhage,symptomatic intracranial hemorrhage,gastrointestinal bleeding,and deep vein thrombosishad no significant difference between the two groups.For those with BNP≤912.5pg/mL,the differences of improved rate of NIHSS and mRS betweenthe two groups were not statistically significant.The mortality and the incidence of cerebral infarction recurrence in antiplatelet group were higher thanthose in anticoagulant group without statistical significance.The incidences of all kinds of bleeding,intracranial hemorrhage,symptomatic intracranialhemorrhage,gastrointestinal bleeding,and deep vein thrombosis were not significantly different between the two groups.Conclusion·Acute cerebralinfarction patients with atrial fibrillation and BNP>912.5pg/mL may benefit more from anticoagulants than antiplatelet agents.

关 键 词：脑梗死 心房颤动 B型钠尿肽 抗凝药 抗血小板药 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学]