目的：分析急性脑梗死（ ACI）患者血浆N末端脑钠肽前体（ NT－proBNP）的变化及其与不同梗死面积、梗死部位、颈动脉粥样硬化（ CAA）、神经功能缺损程度及预后的相关性。方法选择2015年2月—2016年9月在蚌埠医学院第二附属医院神经内科住院的发病24 h内的急性脑梗死患者90例作为梗死组，同期健康体检者40例为健康对照组。检测并比较梗死组入院24 h、治疗7 d、治疗14 d及健康对照组血浆NT－proBNP水平，梗死组依照头颅MR检查结果按照梗死面积、梗死部位比较入院24h、治疗7d、治疗14d血浆NT－proBNP水平；应用彩色多普勒超声检测2组颈动脉内膜中层厚度（ IMT），并与入院24 h血浆NT－proBNP水平进行相关性分析；入院时采用美国国立卫生研究院卒中量表（ NIHSS）对梗死组神经功能缺损程度进行分组，并与入院24 h血浆NT－proBNP水平进行相关性分析。结果梗死组患者血浆NT－proBNP水平明显高于健康对照组（ t ＝16．840， P ＝0．00），入院24 h血浆NT－proBNP水平最高，后逐渐下降，2周时最低；重症亚组入院24h血浆NT－proBNP水平明显高于轻症亚组，轻症亚组高于健康对照组（ F ＝102．386， P ＝0．00），且预后渐好转；大面积脑梗死亚组入院24 h、第7天、第14天血浆NT－proBNP水平明显高于中面积脑梗死亚组，中面积脑梗死亚组血浆NT－proBNP 水平明显高于小面积脑梗死亚组（ F ＝188．694、200．641、181．731， P均＝0．000）；前、后循环脑梗死血浆NT－proBNP水平比较差异无统计学意义（ F ＝0．000， P ＞0．05）；2组颈动脉IMT比较差异有统计学意义（ t值＝14．901， P ＝0．000），且梗死组入院24h血浆NT－proBNP水平与NIHSS、IMT呈正相关（ r ＝0．692、0．672， P均＝0．000）。结论急性脑梗死患者急性期血浆NT－proBNP水平明显升高，与梗死面积呈正相关，与梗死部位无关，是颈动脉粥样硬化的危险因素，可以用于评估脑梗死患者病情严重程度及预后。%Objective To analyse acute cerebral infarction ( ACI) patients plasma NT-proBNP and the change of are-a, and different infarction location , carotid atherosclerosis ( CAA) and the correlation between the degree of neural function defect and prognosis .Methods Ninety cases of patients with acute cerebral infarction from February 2015 to September 2016 in the Second Affiliated Hospital of Bengbu Medical College Department of Neurology enrolled as the case group , 40 cases of healthy volunteers were taken as control group .To test and compare the infarction group admitted 24 h, 7 d, 14 d for treat-ment and the healthy control group .Plasma NT-proBNP levels , according to the head MR examination results of the area and position of infarction, were compared at 24h, 7d, 14d, after treatment;used color Doppler ultrasonic to detect 2 groups of ca-rotid artery intima media thickness ( IMT) , and the correlation analysis was performed with NT-proBNP 24 h plasma level of admission;the National Institutes of Health Stroke Scale ( NIHSS) were used to group the degree of nerve function defect in-farction, and the correlation analysis was performed with NT-proBNP 24 h plasma level .Results The NT-proBNP level in plasma of patients with infarction group were significantly higher than the control group ( t =16.840, P =0.00), NT-proBNP 24 h plasma level were the highest , then gradually decreased at 2 weeks minimum; severe sub group admission 24h plasma NT-proBNP level was significantly higher than the mild group , mild sub group higher than healthy group ( F =102.386, P =0.00), and the prognosis was gradually improved;large area cerebral infarction sub group admitted 24 h, seventh days, four-teenth days of plasma NT-proBNP level was significantly higher than that in the area of cerebral infarction subgroup , NT sub-group in the plasma level of proBNP was significantly higher than that of small area cerebral infarction area cerebral infarction subgroup ( F =188.694, F =200.641, F =181.731, P =0.00) before and after; cerebral infarction plasma NT-proBNP levels showed no significant difference ( F =0.000, P >0.05);the 2 groups were statistically significant differences in ca-rotid artery IMT ( t =14.901, P =0.00), and the infarction group’s level of NT-proBNP in plasma of patients with 24h was positively correlated with NIHSS and IMT ( r =0.692, r =0.672, P =0.00).Conclusion Acute cerebral infarction in pa-tients with acute phase plasma NT-proBNP levels were significantly increased and the infarct size was positively correlated with the infarction site , is a risk factor for carotid atherosclerosis , can be used to assess the severity of cerebral infarction patients and prognosis .
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