| 35 | 0 | 91 |
| 下载次数 | 被引频次 | 阅读次数 |
目的：探讨QTc间期、血清N端B型钠尿肽前体(NT-proBNP)及其联合在急性缺血性脑梗死患者短期预后中的预测价值。方法：回顾性分析2019年1月—2024年9月在宜昌市中心人民医院神经内科住院确诊急性缺血性脑梗死患者123例，治疗3个月后根据改良Rankin量表(mRS)评分将急性脑梗死患者分为预后良好组(n=63例)(mRS评分<3分)和预后不良组(n=60例)(mRS评分≥3分),比较两组患者的一般资料、QTc间期和NT-proBNP。采用Pearson相关性分析及多因素Logistic回归来分析急性脑梗死患者短期预后不良的独立危险因素，并绘制受试者工作特征(ROC)曲线。结果：两组患者一般临床资料比较，预后不良组年龄、QTc间期和NT-proBNP均高于预后良好组(均P<0.05)。Pearson相关性分析显示，患者年龄、QTc间期和NT-proBNP均与mRS评分呈正相关(均P<0.05)。多因素Logistic回归分析结果显示，年龄偏大(OR=1.056,95%CI:1.001,1.115)、QTc间期延长(OR=1.018,95%CI:1.003,1.035)及NT-proBNP升高(OR=1.010,95%CI:1.004,1.017)是急性脑梗死患者短期预后不良的独立危险因素。年龄、QTc间期、NT-proBNP及三者联合预测急性脑梗死患者短期预后不良的ROC曲线下面积分别是0.825、0.804、0.752及0.864。结论：年龄偏大、QTc间期延长及NT-proBNP升高是急性脑梗死患者短期预后不良的独立危险因素，三者联合预测价值更高。
Abstract：Objective: To explote the predictive value of the QTc interval, serum N-terminal pro-B-type natriuretic peptide(NT-proBNP), and their combination for short-term prognosis in patients with acute cerebral infarction. Methods: A retrospective analysis was conducted on 123 patients diagnosed with acute cerebral infarction who were hospitalized in the department of neurology at Yichang Central People's Hospital from January 2019 to September 2024. Based on the modified rankin scale(mRS) score, patients were classified into a good prognosis group(n=63)(mRS score < 3) and a poor prognosis group(n=60)(mRS score ≥ 3) after 3 months of treatment. Demographic data, QTc interval, and NT-proBNP levels were compared between the two groups. Pearson correlation analysis and multivariate Logistic regression were performed to identify independent risk factors associated with poor short-term prognosis, and the receiver operating characteristic curve was drawn. Results: Compared with the good prognosis group, the poor prognosis group had significantly higher levels of age, QTc interval, and NT-proBNP(all P<0.05). Pearson correlation analysis revealed that age, QTc interval, and NT-proBNP were positively correlated with mRS scores(all P<0.05). Multivariate Logistic regression analysis demonstrated that advanced age(OR=1.056, 95%CI: 1.001, 1.115), prolonged QTc interval(OR=1.018, 95%CI: 1.003, 1.035), and elevated NT-proBNP(OR=1.010, 95%CI: 1.004, 1.017) were independent risk factors for poor short-term prognosis in patients with acute cerebral infarction. The areas under the ROC curve for age, QTc interval, NT-proBNP, and their combined model in predicting poor prognosis were 0.825, 0.804, 0.752 and 0.864, respectively. Conclusion: Advanced age, prolonged QTc interval, and elevated NT-proBNP are independent risk factors for poor short-term prognosis in patients with acute cerebral infarction. The combined assessment of these factors provides greater predictive accuracy.
[1] GBD 2016 Stroke Collaborators.Global,regional,and national burden of stroke,1990-2016:a systematic analysis for the global burden of disease study 2016[J].Lancet Neurol,2019,18(5):439-458.
[2] Scheitz J F,Sposato L A,Schulz-Menger J,et al.Stroke-heart syndrome:recent advances and challenges[J].J Am Heart Assoc,2022,11(17):e026528.
[3] Sposato L A,Lam M,Allen B,et al.First-ever ischemic stroke and increased risk of incident heart disease in older adults[J].Neurology,2020,94(15):e1559-e1570.
[4] Sposato L A,Hilz M J,Aspberg S,et al.Post-stroke cardiovascular complications and neurogenic cardiac injury[J].J Am Coll Cardiol,2020,76(23):2768-2785.
[5] Longhitano Y,Bottinelli M,Pappalardo F,et al.Electrocardiogram alterations in non-traumatic brain injury:a systematic review[J].J Clin Monit Comput,2024,38(2):407-414.
[6] 何路遥，于文娟，黄晶晶，等.第2代抗精神病药引起QTc间期延长的研究进展[J].中华精神科杂志，2021,54(1):50-56.
[7] Ahn S H,Lee J S,Kim Y H,et al.Prognostic significance of prolonged corrected QT interval in acute ischemic stroke[J].Front Neurol,2021,12:759822.
[8] Ahn S H,Lee J S,Yun M S,et al.Corrected QTc interval combined with troponin value and mortality in acute ischemic stroke[J].Front Cardiovasc Med,2023,10:1253871.
[9] 李雪花.慢性心力衰竭合并心房颤动患者死亡的危险因素分析[J].巴楚医学，2022,5(2):38-41.
[10] Siedler G,Sommer K,Macha K,et al.Heart failure in ischemic stroke:relevance for acute care and outcome[J].Stroke,2019,50(11):3051-3056.
[11] 中华医学会心血管病学分会，中国医师协会心血管内科医师分会，中国医师协会心力衰竭专业委员会，等.中国心力衰竭诊断和治疗指南2024[J].中华心血管病杂志，2024,52(3):235-275.
[12] Srisujikul P,Thiankhaw K,Tanprawate S,et al.Serum NT-proBNP level for predicting functional outcomes after acute ischemic stroke[J].Sci Rep,2023,13:13903.
[13] 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2018[J].中华神经科杂志，2018,51(9):666-682.
[14] Nandana J,Gopalakrishnan A,Sukumaran S.Beyond arrhythmias in the ECG:Is there any correlation between QT interval and stroke subtype and severity [J].J Clin Neurosci,2025,133:111045.
[15] de Jesus M,Maheshwary A,Kumar M,et al.Association of electrocardiographic and echocardiographic variables with neurological outcomes after ischemic stroke[J].Am Heart J Plus ,2023,34:100313.
[16] Tang H F,Sun J Y,Wang Y,et al.QT interval dispersion as a predictor of clinical outcome in acute ischemic stroke[J].Front Neurol,2021,11:974.
[17] Cao R Y,Lu Y,Qi P,et al.Collateral circulation and BNP in predicting outcome of acute ischemic stroke patients with atherosclerotic versus cardioembolic cerebral large-vessel occlusion who underwent endovascular treatment[J].Brain Sci,2023,13(4):539.
[18] Zhao Y H,Gao H,Pan Z Y,et al.Prognostic value of NT-proBNP after ischemic stroke:a systematic review and meta-analysis of prospective cohort studies[J].J Stroke Cerebrovasc Dis,2020,29(4):104659.
[19] 郭琳.脑钠肽、同型半胱氨酸测定在急性脑梗死诊治中的作用[J].中国基层医药，2024,31(6):869-873.
[20] Wang M,Peng Y.Advances in brain-heart syndrome:attention to cardiac complications after ischemic stroke[J].Front Mol Neurosci,2022,15:1053478.
[21] Usalp S,Ba■ novel electrocardiographic marker for predicting total mortality in ischemic stroke:frontal QRS-T angle[J].Turk Kardiyol Dern Ars,2025,53(1):29-34.
[22] Charisopoulou D,Koulaouzidis G,Rydberg A,et al.Abnormal ventricular repolarization in long QT syndrome carriers is related to short left ventricular filling time and attenuated stroke volume response during exercise[J].Echocardiography,2018,35(8):1116-1123.
基本信息:
中图分类号:R743.33
引用信息:
[1]曹姗姗,杨英,李颖,等.QTc间期和NT-proBNP在评估急性脑梗死患者短期预后中的价值[J].巴楚医学,2025,8(04):64-69.
基金信息:
湖北省自然科学基金项目(2023AFB104)
2025-12-30
2025-12-30