BNP和cTnI在鉴别急性缺血性脑卒中心源性卒中的价值

    Value of BNP and cTnI in differentiating cardiogenic stroke of acute ischemic stroke

    • 摘要:
      目的 探讨血浆脑钠肽(BNP)水平和血清肌钙蛋白I(cTnI)作为生物标志物对诊断心源性卒中的临床价值。
      方法 回顾性分析发病24 h内的急性缺血性卒中病人235例, 其中, 心源性卒中66例, 非心源性卒中169例。通过对2组卒中病人之间血浆BNP、cTnI水平的比较, 明确BNP及cTnI水平对心源性卒中诊断的最佳临界值, 并对比两者对心源性卒中的诊断价值。
      结果 心源性卒中组和非心源性卒中组相比, 前者年龄更大(P < 0.01)、左房内径更大(P < 0.01)、房颤以及二尖瓣反流发生率更高(P < 0.01), 其患糖尿病比例更低(P < 0.05)、白蛋白ALB更小(P < 0.01)。心源性卒中病人血浆BNP水平及cTnI值均明显高于非心源性卒中病人(P < 0.01), 血浆BNP水平ROC曲线下面积为0.986, 其95%可信区间为0.972~0.999。cTnI值ROC曲线下面积0.941, 其95%可信区间为0.896~0.987。血浆BNP水平诊断心源性卒中最佳临界点为89.31 pg/mL(敏感性92.4%, 特异性98.8%), cTnI区分心源性卒中与非心源性卒中的最佳诊断截点为0.019 5 ng/mL(敏感性87.9%, 特异性95.9%)。
      结论 缺血性脑卒中病人的血浆BNP水平和cTnI值分别超过89.31 pg/mL和0.019 5 ng/mL时, 对心源性卒中与非心源性卒中的鉴别诊断有着重要的临床意义, 且血浆BNP水平对诊断心源性卒中的临床价值高于cTnI。

       

      Abstract:
      Objective To investigate the clinical value of plasma brain natriuretic peptide(BNP) levels and serum troponin I(cTnI) as biomarkers for the diagnosis of cardiogenic stroke.
      Methods The clinical data of 235 patients with acute ischemic stroke(including 66 cases of cardiac stroke and 169 cases of non-cardiogenic stroke).By comparing the plasma BNP and cTnI levels between two groups, the optimal cut-off values of BNP and cTnI levels in the diagnosis of cardiogenic stroke were determined, and the diagnostic value of the two was compared.
      Results Compared with the non-cardiogenic stroke group, the older age(P < 0.01), larger left atrial diameter(P < 0.01), higher incidence of atrial fibrillation and mitral regurgitation(P < 0.01), lower incidence of diabetes(P < 0.05) and smaller albumin in the cardiogenic stroke group were found(P < 0.01).The plasma BNP level and cTnI value in patients with cardiogenic stroke were significantly higher than those in patients without cardiogenic stroke(P < 0.01).The area under the ROC curve of plasma BNP level was 0.986, and the 95% confidence interval was 0.972-0.999.The area under the ROC curve of cTnI value was 0.941, and its 95% confidence interval was 0.896-0.987.The optimal cut-off point of plasma BNP level for the diagnosis of cardiogenic stroke was 89.31 pg/mL(sensitivity for 92.4% and specificity for 98.8%), and the optimal cut-off point of cTnI for distinguishing cardiogenic stroke from non-cardiogenic stroke was 0.019 5 ng/mL(sensitivity for 87.9%, specificity for 95.9%).
      Conclusions When the plasma BNP level and cTnI value of ischemic stroke patients exceed 89.31 pg/mL and 0.019 5 ng/mL, respectively, it has important clinical significance for the differential diagnosis of cardiogenic stroke and non-cardiogenic stroke, and the clinical value of plasma BNP level in the diagnosis of cardiogenic stroke is higher than that of cTnI.

       

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