血清BNP水平及左房内径对脑梗死合并阵发性房颤的辅助诊断价值

Diagnostic Value of Serum BNP and Left Atrial Diameter in Paroxysmal Atrial Fibrillation with Cerebral Embolism

摘要: 目的：通过比较不同房颤类型引起的心源性脑卒中患者血清脑钠钛(BNP)、D-二聚体、纤维蛋白原、C-反应蛋白(CRP)等指标及超声检测左房前后径大小，评估其在心源性脑梗死患者中合并阵发性房颤诊断中的价值，以指导治疗，预防再栓塞。方法：回顾性收集2017年6月至2020年6月在青岛大学附属医院神经内科接诊合并房颤的急性心源性脑梗死患者185例，其中持续性房颤患者104例、阵发性房颤患者81例，并选择同时期非心源性脑梗死患者115例，比较各组发病72 h之内的血清D-二聚体、纤维蛋白原、脑钠肽(BNP)、C-反应蛋白(CRP)，在院住院期间心脏超声测得的左房前后径大小。结果：1) 持续性、阵发性房颤组BNP水平明显高于对照组，差异有显著性(P < 0.05)，而持续性和阵发性房颤组之间差异无统计学意义(P > 0.05)。2) 三组发病住院期间测量的左心房前后径大小有明显差异(4.71 ± 0.83, 4.12 ± 0.59, 3.81 ± 0.47)，各组间差异有统计学意义(P < 0.05)。3) 多因素logistic回归分析显示，BNP水平升高(OR = 1.02, 95% CI: 1.02~1.03, P < 0.001)和左房前后径增大(cm) (OR = 3.00, 95% CI: 1.04~8.71, P = 0.043)是阵发性房颤类型脑梗死的独立危险因素。结论：房颤引起心源性栓塞患者血浆BNP水平明显高于无心源性脑栓塞患者，房颤患者左心房前后径增大，持续性较阵发性房颤患者更加明显，血清BNP水平升高和左房前后径增大是阵发性房颤心源性脑梗死的独立危险因素。

Abstract: Purpose: By comparing the serum brain natriuretic peptides (BNP), D-dimer, fibrinogen, C-reactive protein (CRP), and the anteroposterior diameter of the left atrium (LA) detected by ultrasound, in patients with cardiogenic stroke caused by different types of atrial fibrillation (AF), to evaluate its value in the diagnosis of cardiogenic stroke to guide treatment and prevent re-embolism. Methods: A retrospective collection of 185 patients with acute cardiogenic cerebral infarction with AF in the Department of Neurology of Qingdao University Affiliated Hospital from June 2017 to June 2020, including 104 patients with persistent atrial fibrillation (PeAF) and 81 patients with paroxysmal atrial fibrillation (PaAF), and 115 patients with ischemic cerebral infarction without AF during the same period were selected. Serum D-dimer, fibrinogen, BNP and CRP in each group within 72 hours of onset, and the anteroposterior diameter of the LA measured by ultrasound during the hospital stay, were compared. Results: 1) The BNP level of PeAF and PaAF group was significantly higher than that of the control group, and the difference is significant (P < 0.05), while the difference between PeAF and PaAF group is not statistically significant (P > 0.05). 2) The anteroposterior diameters of the LA measured among the three groups are significantly different (cm) (4.71 ± 0.83, 4.12 ± 0.59, 3.81 ± 0.47), and the differences between the groups are statistically significant (P < 0.05). 3) Multivariate logistic regression analysis showed that BNP (OR = 1.02, 95%CI: 1.02~1.03, P < 0.001) and LA anteroposterior diameter (OR = 3.00, 95% CI: 1.04~8.71, P = 0.043) are independent risk factors for PaAF with cerebral embolism patients. Conclusion: The serum BNP level of patients with cardiogenic embolism caused by AF is significantly higher than that of patients with non-cardiogenic cerebral embolism. The anteroposterior diameter of LA in patients with AF is enlarged, and the PeAF is more obvious than that in patients with PaAF. Serum BNP and LA anteroposterior diameter are independent risk factors of cardiogenic cerebral embolism caused by PaAF.