心脏生物标志物对卒中后死亡风险的预测价值
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1.南京医科大学第一附属医院心血管内科;2.南京医科大学第一附属医院介入放射科

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国家自然科学基金委员会面上项目(编号:82270329)


Predictive Value of Cardiac Biomarkers for Post-Stroke Mortality Risk
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Affiliation:

Department of Cardiology,First Affiliated Hospital of Nanjing Medical University

Fund Project:

The National Natural Science Foundation of China (General Program, Key Program, Major Research Plan)(82270329)

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    摘要:

    [摘要] 目的:探讨心脏生物标志物N-末端B型脑钠肽前体(N-terminal pro-brain natriuretic peptide, NT-proBNP)和高敏肌钙蛋白T(high-sensitivity cardiac troponin T, hs-cTnT)在急性缺血性卒中(acute ischemic stroke,AIS)患者长期死亡风险预测中的价值,并构建和验证相关预测模型。方法:本研究为单中心回顾性研究,连续入选2022年1月至2022年12月在南京医科大学第一附属医院接受取栓术的AIS患者,随访2年。通过Cox回归和LASSO回归筛选全因死亡相关因素,构建三种预测模型,分别为基础模型、模型1(基础模型+NT-proBNP)和模型2(基础模型+hs-cTnT),并比较不同模型的预测能力。结果:最终纳入230例患者,按3:2比例随机分为训练集(n=146)和测试集(n=84)。随访期间共发生83例全因死亡事件,死亡率为37.2%。多因素Cox回归显示,NT-proBNP每升高1000pg/ml,2年全因死亡风险增加27%(HR=1.27,95%CI:1.15-1.40,p<0.001);而In(hs-cTnT)升高与死亡风险无显著关联(HR=1.11,95%CI:0.89-1.38,p=0.372)。通过Cox回归和LASSO回归最终筛选出以下与全因死亡风险相关的变量:既往房颤、术后NIHSS(national institutes of health stroke scale)评分、基线血红蛋白、白细胞计数以及随机血糖,并基于此构建基础模型。基础模型训练集和测试集的受试者工作特征曲线下面积(area under the curve,AUC)分别为0.816和0.778。模型1的训练集和测试集的AUC分别为0.866和0.799,提高了对全因死亡风险的预测能力。模型2的训练集和测试集的AUC分别为0.811和0.788,对全因死亡风险的预测能力提升不明显。结论:NT-proBNP是AIS患者全因死亡的独立预测因子,可提高基于传统临床指标模型的死亡风险预测能力,辅助AIS患者的个体化管理。

    Abstract:

    [Abstract] Objective: To investigate the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) in predicting long-term mortality risk in patients with acute ischemic stroke (AIS) and to develop and validate predictive models. Methods: This study is a single-center, retrospective study. AIS patients who underwent thrombectomy at the First Affiliated Hospital of Nanjing Medical University between January 2022 and December 2022 were enrolled and followed up for two years. Cox regression and LASSO regression were used to identify factors associated with all-cause mortality. Three predictive models were constructed: basic model, Model 1 (basic model + NT-proBNP), and Model 2 (basic model + hs-cTnT), and their predictive performances were compared. Results: A total of 230 AIS patients were included in the final analysis and were randomly assigned to the training set (n=146) and testing set (n=84). During the follow-up period, 83 all-cause deaths were recorded, with a mortality rate of 37.2%. Multivariate Cox regression showed that each 1000 pg/mL increase in NT-proBNP was associated with a 27% higher risk of 2-year all-cause death (HR = 1.27, 95% CI: 1.15-1.40, p < 0.001). In contrast, ln(hs-cTnT) was not significantly associated with mortality risk (HR = 1.11, 95% CI: 0.89-1.38, p = 0.372). Cox regression and LASSO identified the following mortality-related variables: history of atrial fibrillation, postoperative national institutes of health stroke scale (NIHSS), baseline hemoglobin, white blood cell count, and random blood glucose. These were used to build basic model. Area under the curve (AUC) of basic model was 0.816 in the training set and 0.778 in the testing set. Model 1 had an AUC of 0.866 in the training set and 0.799 in the testing set, showing improved predictive performance. Model 2 had an AUC of 0.811 in the training set and 0.788 in the testing set, with no significant improvement. Conclusion: NT-proBNP is an independent predictor of all-cause mortality in AIS patients and can enhance the predictive ability of mortality risk based on traditional clinical parameter models, contributing to the individualized management of AIS patients.

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  • 收稿日期:2025-02-11
  • 最后修改日期:2025-04-18
  • 录用日期:2025-06-11
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