Relationship between serum B-type natriuretic peptide, D-dimer, C reactive protein and short-termprognosis in patients with massive cerebral infarction in subacute phase
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摘要:目的 探讨大面积脑梗死(MCI)亚急性期血清B型钠尿肽(BNP)、D-二聚体(D-D)及C反应蛋白(CRP)与短期预后的关系。方法 选取MCI患者137例，在常规治疗和护理基础上检测急性期血清BNP、D-D及CRP水平，并与健康体检者比较。根据MCI患者随访3个月时预后情况分为预后良好组和预后不良组，比较2组血清BNP、D-D及CRP水平。采用多因素Logistic回归分析和ROC曲线判断各指标对MCI患者短期预后的影响及预测价值。结果 MCI患者BNP、D-D及CRP水平显著高于健康体检者(P < 0.05); 137例MCI患者中预后不良者46例，预后良好组BNP、D-D及CRP水平均显著低于预后不良组(P < 0.05); Logistic回归分析结果显示，BNP、D-D及CRP均是影响MCI患者短期预后的重要因素(P < 0.05)。ROC曲线分析显示，BNP、D-D及CRP预测MCI短期预后的曲线下面积(AUC)分别为0.912、0.806和0.863，灵敏度分别为0.848、0.870和0.913，特异度分别为0.912、0.703和0.670。结论 BNP、D-D及CRP均是影响亚急性期MCI患者预后的重要因素，可用于监测病情进展，对于短期预后判断也具有较高临床价值。Abstract:Objective To explore the relationship between serum B-type natriuretic peptide (BNP), D-dimer (D-D), C reactive protein (CRP) and short-term prognosis in patients with massive cerebral infarction (MCI) in subacute phase.Methods Totally 137 MCI patients were selected and conducted detections of serum BNP, D-D and CRP in acute phase on the basis of routine treatment and nursing, and Results were compared with healthy controls. According to the condition of prognosis at 3 months of follow-up, the MCI patients were divided into good prognosis group and poor prognosis group, and the levels of serum BNP, D-D and CRP were compared between the two groups. Multivariate Logistic regression analysis and ROC curve were used to judge the effects and predictive value of each indicator on the short-term prognosis of MCI patients.Results The levels of BNP, D-D and CRP in MCI patients were significantly higher than those in healthy controls (P < 0.05). Among the 137 MCI patients, there were 46 patients with poor prognosis, and the levels of BNP, D-D and CRP in good prognosis group were significantly lower than those in poor prognosis group (P < 0.05). Logistic regression analysis showed that BNP, D-D and CRP were important influencing factors for short-term prognosis of patients with MCI (P < 0.05). ROC curve analysis showed that the Area under the curve (AUC) values of BNP, D-D and CRP in predicting short-term prognosis of MCI were 0.912, 0.806 and 0.863 respectively, and the sensitivities were 0.848, 0.870 and 0.913, respectively, and the specificities were 0.912, 0.703 and 0.670, respectively.Conclusion BNP, D-D and CRP are important influencing factors for prognosis of patients with MCI in subacute phase. These indexes can be used to monitor the progression of disease, and they show a high clinical value in the judgment of short-term prognosis.
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表 1 MCI组与对照组BNP、D-D及CRP水平比较(x±s)
组别 n BNP/(pg/L) D-D/(ng/L) CRP/(mg/L) MCI组 137 364.29±52.37* 1 825.06±219.78* 23.17±4.02* 对照组 120 58.41±13.94 291.53±32.45 2.61±0.73 BNP: B型钠尿肽; D-D: D-二聚体; CRP: C反应蛋白。与对照组比较, *P < 0.05。 
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表 2 不同预后MCI患者BNP、D-D及CRP水平比较(x±s)
组别 n BNP/(pg/L) D-D/(ng/L) CRP/(mg/L) 预后良好组 91 312.58±49.26* 1 682.94±207.65* 20.36±3.12* 预后不良组 46 406.92±70.39 1 921.47±256.13 24.09±3.71 BNP: B型钠尿肽; D-D: D-二聚体; CRP: C反应蛋白。与预后不良组比较, *P < 0.05。
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表 3 MCI患者短期预后相关因素的Logistic回归分析
相关因素 β SE χ2 OR 95%CI P BNP 0.713 0.294 5.881 2.040 1.147~3.630 0.016 D-D 0.486 0.147 10.930 1.626 1.219~2.169 0.001 CPR 0.537 0.218 6.068 1.711 1.116~2.623 0.014
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表 4 BNP、D-D及CRP对MCI患者短期预后的评估价值分析
指标 灵敏度 特异度 Youden指数 AUC 95%CI BNP 0.848 0.912 0.760 0.912 0.851~0.953 D-D 0.870 0.703 0.573 0.806 0.730~0.869 CRP 0.913 0.670 0.583 0.863 0.793~0.915
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