联合血压变异性和血清N端脑钠肽前体在急性脑梗死中的临床研究
|
摘要
目的探讨急性脑梗死患者血压变异性和血清N端脑钠肽前体(NT-pro-BNP)的水平变化及其两者之间的关系。方法选取急性脑梗死患者78例作为脑梗死组,抽取56例为对照组,为本院同期非脑血管疾病患者;对比分析组间血压变异性、血清NT-pro-BNP水平;对比分析脑梗死组亚组间(脑梗死面积、脑梗死部位、是否合并高血压病、随访90d时的预后)血压变异性、血清NT-pro-BNP水平。结果脑梗死组血压变异性、血清NT-pro-BNP水平显著高于对照组(P<0.05);大面积脑梗死组和脑梗死死亡组患者血清NT-pro-BNP水平和24h收缩压变异系数、24h舒张压变异系数、白昼收缩压变异系数、白昼舒张压变异系数、夜间收缩压变异系数及夜间舒张压变异系数均分别明显高于非大面积脑梗死组与脑梗死存活组(P<0.01);脑梗死合并高血压病组血清NT-pro-BNP水平和24h收缩压变异系数、白昼收缩压变异系数、白昼舒张压变异系数、夜间收缩压变异系数及夜间舒张压变异系数均显著高于脑梗死且血压正常组(P<0.05);前循环供血区脑梗死组与后循环供血区脑梗死组的24h收缩压变异系数、24h舒张压变异系数、白昼收缩压变异系数、白昼舒张压变异系数、夜间收缩压变异系数及夜间舒张压变异系数均有明显差异(P<0.05)。血清NT-pro-BNP水平与血压变异性相关指标24h收缩压变异系数、24h舒张压变异系数、白昼收缩压变异系数、白昼舒张压变异系数、夜间收缩压变异系数及夜间舒张压变异系数等呈正相关(r=0.339,0.341,0.339,0.330,0.380,0.374,P<0.01)。结论急性脑梗死患者血压变异性和血清N端脑钠肽前体(NT-pro-BNP)的水平明显升高,且血清NT-pro-BNP水平与血压变异性有关。
Objective To explore blood pressure variability and the serum N-terminal pro-brain natriuretic peptide(NT-pro-BNP)level changes and the relation between blood pressure variability and NT-proBNP level in patients with acute ischemic stroke.Methods 78 patients with acute ischemic stroke within 48 hours of onset and 56 cases in the control group were enrolled in this study.The blood pressure variability and the serum levels of NT-pro-BNP on admission,size of infarction,region of infarction,with hypertension or without hypertension,and prognosis of follow-up for 90 days were measured.Results Blood pressure variability and the serum levels of NT-pro-BNP were significantly higher in the acute ischemic stroke group than those in the control group(P<0.05),Blood pressure variability and the serum levels of NT-pro-BNP were significantly higher in patients with massive cerebral infarction group and death group than those in patients without the conditions(P<0.05).Compared with patients without hypertension group,Blood pressure variability and the serum levels of NT-pro-BNP were increased in the patients with hypertension group(P<0.05).Only blood pressure variability in anterior circulation cerebral infarction group was higher than that in posterior circulation cerebral infarction group(P<0.05).The relationship between NT-Pro-BNP and blood pressure variability was a positive linear correlation(r=0.339,0.341,0.339,0.330,0.380,0.374,P<0.01).Conclusion Blood pressure variability and the serum levels of NT-pro-BNP were increased after acute ischemic stroke.Blood pressure variability was correlation with the serum levels of NT-pro-BNP.
Objective To explore blood pressure variability and the serum N-terminal pro-brain natriuretic peptide(NT-pro-BNP)level changes and the relation between blood pressure variability and NT-proBNP level in patients with acute ischemic stroke.Methods 78 patients with acute ischemic stroke within 48 hours of onset and 56 cases in the control group were enrolled in this study.The blood pressure variability and the serum levels of NT-pro-BNP on admission,size of infarction,region of infarction,with hypertension or without hypertension,and prognosis of follow-up for 90 days were measured.Results Blood pressure variability and the serum levels of NT-pro-BNP were significantly higher in the acute ischemic stroke group than those in the control group(P<0.05),Blood pressure variability and the serum levels of NT-pro-BNP were significantly higher in patients with massive cerebral infarction group and death group than those in patients without the conditions(P<0.05).Compared with patients without hypertension group,Blood pressure variability and the serum levels of NT-pro-BNP were increased in the patients with hypertension group(P<0.05).Only blood pressure variability in anterior circulation cerebral infarction group was higher than that in posterior circulation cerebral infarction group(P<0.05).The relationship between NT-Pro-BNP and blood pressure variability was a positive linear correlation(r=0.339,0.341,0.339,0.330,0.380,0.374,P<0.01).Conclusion Blood pressure variability and the serum levels of NT-pro-BNP were increased after acute ischemic stroke.Blood pressure variability was correlation with the serum levels of NT-pro-BNP.
引文
[1]Zhao D,Liu J,Wang W,et al.Epidemiological transition of stroke in China[J].Stroke,2008,39(6):1668-1674.
[2]Parati G,Ochoa JE,Lombardi C,et al.Assessment and management of blood-pressure variability[J].Nat Rev Cardiol,2013,10(3):143-155.
[3]中华医学会.全国第四届中华医学会第四次脑血管病学术会议.各项脑血管病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[4]黄如训,郭玉璞.脑卒中的分型分期治疗(建议草案)[J].中国神经精神疾病杂志,2001,27(1):73.
[5]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[6]Alqadri SL,Sreenivasan V,Qureshi AI.Acute hypertensive response management in patients with acute stroke[J].Curr Cardiol Rep,2013,15(12):426.
[7]Qureshi AI.Acute hypertensive response in patients with stroke:pathophysiology and management[J].Circulation,2008,118(2):176-187.
[8]Kollias A,Kyriakoulis K,Karpettas N,et al.Home blood pressure variability and preclinical target-organ damage in untreated hypertension[J].Journal of Hypertens,2018,36:e173.
[9]柴琴琴,武崇光,林杰,等.血压变异性与卒中的预后[J].中国卒中杂志,2018,13(2):194-198.
[10]李朦朦.高血压的血压变异性与靶器官损害的研究进展[J].临床与病理杂志,2017,37(4):835-840.
[11]刘骏,杜瑞雪,王亮,等.高血压患者血压变异性临床研究进展[J].中华老年心脑血管病杂志,2017,19(10):1103-1105.
[12]Rothwell PM,Howard SC,Dolan E,et al.Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke[J].Lancet Neurol,2010,9(5):469-480.
[13]Tan ZF,Meng H,Xing XF,et al.Blood pressure variability estimated by average real variability predicts stroke in progression of acute ischemic stroke[J].Biomedical Research,2018,29(5):1001-1007.
[14]李宁.大面积脑梗死亚急性期血压变异性与短期预后的关系[D].南宁:广西医科大学,2016.
[15]De Havenon A,Bennett A,Stoddard GJ,et al.Increased blood pressure variability is associated with worse neurologic outcome in acute anterior circulation ischemic stroke[J].Stroke Res Treat,2016(6):7670161.
[16]刘宁.前后循环脑梗死患者动态血压特点分析[J].海南医学院学报,2012,18(4):476-478.
[17]南宇飞,卢翠莲,严之红.合并H型高血压的急性脑梗死患者血压变异性及其临床意义[J].中国医学装备,2018,15(1):78-81.
[18]石铸,李淑恩,李瑞兰,等.非心源性脑梗死患者急性期血压变异与早期神经功能恶化的相关性研究[J].中国神经精神疾病杂志,2016,42(6):357-361.
[19]Yu JM,Kong QY,Schoenhagen P,et al.The prognostic value of long-term visit-to-visit blood pressure variability on stroke in real-world practice:a dynamic cohort study in a large representative sample of Chinese hypertensive population[J].Int JCardiol,2014,177(3):995-1000.
[20]李海华,胡振龙,陈甜,等.急性脑梗死患者血清脑利钠肽动态变化及临床意义[J].重庆医学,2014,43(24):3226-3228.
[21]汪进丁,罗江洪,徐丽君,等.N端脑钠肽前体与急性脑梗死患者预后的相关性[J].中国神经精神疾病杂志,2014,40(11):646-651.
[22]De Lemos JA.Mcguire darren K,drazner mark H.b-type natriuretic peptide in cardiovascular disease[J].Lancet,2003,362(9380):316-322.
[23]Wang R,Wei YM,Teng JF.Levels of plasma n-terminal probrain natriuretic peptide and D-dimer on the prognosis of patients with acute cerebral infarction[J].Pakistan Journal of Medical Sciences,2018,34(4):855.
[24]Yang Q,Li C,Wang L,et al.Clinical significance of serum NT-proBNP in patients with acute cerebral stroke[J].Panminerva Med,2018.
[25]De GM,Schneider J,Weck A,et al.Midregional proatrial natriuretic peptide improves risk stratification after ischemic stroke:Association with mortality and cardioembolic etiology[J].Neurology,2018,91(13):637.
[26]Yang J,Zhong C,Wang A,et al.Association between increased N-terminal pro-brain natriuretic peptide level and poor clinical outcomes after acute ischemic stroke[J].Journal of the Neurological sciences,2017,383:5-10.
[27]韩永全,刘跃亭.关于NT-ProBNP在重型颅脑损伤中临床价值的研究[J].中华神经创伤外科电子杂志,2017,3(6):330-334.
[28]方麒林,沈滔,刘团结,等.急性缺血性脑卒中患者人院时血浆BNP水平与梗死部位关系[J].现代生物医学进展,2014,14(18):3465-3468.
[2]Parati G,Ochoa JE,Lombardi C,et al.Assessment and management of blood-pressure variability[J].Nat Rev Cardiol,2013,10(3):143-155.
[3]中华医学会.全国第四届中华医学会第四次脑血管病学术会议.各项脑血管病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[4]黄如训,郭玉璞.脑卒中的分型分期治疗(建议草案)[J].中国神经精神疾病杂志,2001,27(1):73.
[5]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[6]Alqadri SL,Sreenivasan V,Qureshi AI.Acute hypertensive response management in patients with acute stroke[J].Curr Cardiol Rep,2013,15(12):426.
[7]Qureshi AI.Acute hypertensive response in patients with stroke:pathophysiology and management[J].Circulation,2008,118(2):176-187.
[8]Kollias A,Kyriakoulis K,Karpettas N,et al.Home blood pressure variability and preclinical target-organ damage in untreated hypertension[J].Journal of Hypertens,2018,36:e173.
[9]柴琴琴,武崇光,林杰,等.血压变异性与卒中的预后[J].中国卒中杂志,2018,13(2):194-198.
[10]李朦朦.高血压的血压变异性与靶器官损害的研究进展[J].临床与病理杂志,2017,37(4):835-840.
[11]刘骏,杜瑞雪,王亮,等.高血压患者血压变异性临床研究进展[J].中华老年心脑血管病杂志,2017,19(10):1103-1105.
[12]Rothwell PM,Howard SC,Dolan E,et al.Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke[J].Lancet Neurol,2010,9(5):469-480.
[13]Tan ZF,Meng H,Xing XF,et al.Blood pressure variability estimated by average real variability predicts stroke in progression of acute ischemic stroke[J].Biomedical Research,2018,29(5):1001-1007.
[14]李宁.大面积脑梗死亚急性期血压变异性与短期预后的关系[D].南宁:广西医科大学,2016.
[15]De Havenon A,Bennett A,Stoddard GJ,et al.Increased blood pressure variability is associated with worse neurologic outcome in acute anterior circulation ischemic stroke[J].Stroke Res Treat,2016(6):7670161.
[16]刘宁.前后循环脑梗死患者动态血压特点分析[J].海南医学院学报,2012,18(4):476-478.
[17]南宇飞,卢翠莲,严之红.合并H型高血压的急性脑梗死患者血压变异性及其临床意义[J].中国医学装备,2018,15(1):78-81.
[18]石铸,李淑恩,李瑞兰,等.非心源性脑梗死患者急性期血压变异与早期神经功能恶化的相关性研究[J].中国神经精神疾病杂志,2016,42(6):357-361.
[19]Yu JM,Kong QY,Schoenhagen P,et al.The prognostic value of long-term visit-to-visit blood pressure variability on stroke in real-world practice:a dynamic cohort study in a large representative sample of Chinese hypertensive population[J].Int JCardiol,2014,177(3):995-1000.
[20]李海华,胡振龙,陈甜,等.急性脑梗死患者血清脑利钠肽动态变化及临床意义[J].重庆医学,2014,43(24):3226-3228.
[21]汪进丁,罗江洪,徐丽君,等.N端脑钠肽前体与急性脑梗死患者预后的相关性[J].中国神经精神疾病杂志,2014,40(11):646-651.
[22]De Lemos JA.Mcguire darren K,drazner mark H.b-type natriuretic peptide in cardiovascular disease[J].Lancet,2003,362(9380):316-322.
[23]Wang R,Wei YM,Teng JF.Levels of plasma n-terminal probrain natriuretic peptide and D-dimer on the prognosis of patients with acute cerebral infarction[J].Pakistan Journal of Medical Sciences,2018,34(4):855.
[24]Yang Q,Li C,Wang L,et al.Clinical significance of serum NT-proBNP in patients with acute cerebral stroke[J].Panminerva Med,2018.
[25]De GM,Schneider J,Weck A,et al.Midregional proatrial natriuretic peptide improves risk stratification after ischemic stroke:Association with mortality and cardioembolic etiology[J].Neurology,2018,91(13):637.
[26]Yang J,Zhong C,Wang A,et al.Association between increased N-terminal pro-brain natriuretic peptide level and poor clinical outcomes after acute ischemic stroke[J].Journal of the Neurological sciences,2017,383:5-10.
[27]韩永全,刘跃亭.关于NT-ProBNP在重型颅脑损伤中临床价值的研究[J].中华神经创伤外科电子杂志,2017,3(6):330-334.
[28]方麒林,沈滔,刘团结,等.急性缺血性脑卒中患者人院时血浆BNP水平与梗死部位关系[J].现代生物医学进展,2014,14(18):3465-3468.