血浆BNP和D-二聚体与老年脑梗死患者神经功能缺损评分及预后的关系  

Relationship of plasma BNP and D-dimer with neurological impairment score and prognosis of elderly patients with cerebral infarction

作　　者：崔艳萍 杨源瑞 林秀 肖丕娟 李彩文 吴婕 CUI Yanping;YANG Yuanrui;LIN Xiu;XIAO Pijuan;LI Caiwen;WU Jie(Cadre Ward,General Hospital of Western Theater Command,Chengdu 610083,China)

机构地区：[1]西部战区总医院干部病房一科二病区,四川成都610083

出　　处：《西部医学》2023年第6期858-862,共5页Medical Journal of West China

基　　金：四川省卫生和计划生育委员会科研课题(18PJ151)。

摘　　要：目的探讨血浆B型钠尿肽(BNP)和D-二聚体(D-D)与老年脑梗死(CI)患者神经功能缺损评分及预后的关系。方法选取2018年12月—2021年12月西部战区总医院收治的118例老年CI患者为CI组,另选择同期健康体检者118例为对照组。测定两组血浆BNP、D-D、血脂等生化指标水平。行美国国立卫生研究院卒中量表(NIHSS)评分,将CI组分为轻度组(n=34)、中度组(n=49)和重度组(n=35);并根据随访30 d改良Rankin量表(mRS)评分将其分为预后不良组(n=83)和预后良好组(n=35),比较不同神经损伤程度和预后时血浆BNP、D-D及血脂水平的变化,绘制受试者工作特征(ROC)曲线分析BNP、D-D对老年CI患者预后不良的预测价值。结果CI组吸烟比例、血浆BNP、D-D及LDL-C水平高于对照组(P<0.05);多因素Logistic回归分析显示吸烟、BNP、D-D与CI密切相关(P<0.05);血浆BNP、D-D水平中度组高于轻度组,重度组高于中度组,预后不良组高于预后良好组(均P<0.05);血浆BNP预测老年CI患者预后不良的曲线下面积(AUC)值为0.868,敏感度、特异度分别为70.24%、85.29%,血浆D-D预测老年CI患者预后不良的AUC值为0.809,敏感度、特异度分别为86.90%、70.59%(均P<0.001)。结论BNP、D-D在老年CI患者血浆中呈异常表达,并且与神经功能缺损相关,可用于预测患者预后。Objective To investigate the relationship of plasma B-type natriuretic peptide(BNP)and D-dimer(D-D)with neurological impairment score and prognosis of elderly patients with cerebral infarction(CI).Methods 118 elderly patients with CI admitted to General Hospital of Western Theater Command from December 2018 to December 2021 and 118 healthy individuals who underwent physical examination during the same period were selected as the control group at a ratio of 1:1 as the research subjects.They were included in the CI group and the control group,respectively.The levels of biochemical indexes such as plasma BNP,D-D and blood lipids were measured.According to the National Institutes of Health Stroke Scale(NIHSS)score,patients in the CI group were divided into mild group(n=34),moderate group(n=49)and severe group(n=35).According to the modified Rankin scale(mRS)score,the patients were divided into poor prognosis group(n=83)and good prognosis group(n=35).Changes of plasma BNP,D-D and blood lipid levels in patients with different degrees of nerve injury and different prognosis were compared.Pearson correlation analysis was performed to analyze the relationship of each index with NIHSS score and mRS score.Results The smoking ratio,plasma BNP,D-D and LDL-C levels in the CI group were higher than those in the control group(P<0.05).Multivariate logistic regression analysis showed that smoking,BNP,D-D were closely related to CI(P<0.05).Plasma BNP and D-D levels increased in order from the mild group,the moderate group to the severe group.Plasma BNP and D-D levels in the poor prognosis group were higher than those in the good prognosis group(P<0.05).The area under the curve(AUC)value of plasma BNP for predicting poor prognosis in elderly patients with CI was 0.868,and the sensitivity and specificity were 70.24%and 85.29%,respectively(P<0.001).The AUC value of plasma D-D in predicting poor prognosis in elderly CI patients was 0.809.And the sensitivity and specificity were 86.90%and 70.59%respectively(P<0.001).Conclusion BNP and D

关 键 词：脑梗死 老年患者 血浆钠尿肽 D-二聚体 神经功能缺损 

分 类 号：R743.32[医药卫生—神经病学与精神病学]