Stroke:基于血液的心脏生物标志物与认知能力下降、脑血管疾病和临床事件风险的关系

2021-05-11 MedSci原创 MedSci原创

基于血液的心脏生物标志物水平较高与记忆力下降以及血管事件和死亡风险相关。此外,NT-proBNP和hs-cTnT与脑微出血和皮层梗死有关。

心脏生物标志物,脑钠肽前体N末端(NT-proBNP)、高敏性心脏肌钙蛋白T(hs-cTnT)和生长分化因子-15(GDF-15)已被推荐作为早期血管病理改变的重要生物标志物。然而,关于这些心脏生物标记物与脑血管疾病和临床事件之间的纵向关联知之甚少。

近日,心血管疾病领域权威杂志Stroke上发表了一篇研究文章,研究人员旨在评估以血液为基础的心脏生物标志物(NT-proBNP、hs-cTnT和GDF-15)与认知能力下降、突发性脑血管疾病、血管事件和死亡率之间的关系。

研究人员收集了三百三十四例患者基线时的血样,每年进行3次年度神经心理学评估,并在基线和随访时进行脑磁共振成像扫描。研究人员通过电化学发光免疫测定法测定了NT-proBNP和hs-cTnT浓度,并通过定量夹心免疫法测定了GDF-15水平。根据白质高信号、腔隙、脑微出血、皮质梗塞和颅内狭窄对基线和后续磁共振成像进行分级。

 

心脏生物标志物与血管事件和死亡风险

研究人员发现NT-proBNP、hs-cTnT和GDF-15水平较高的患者的记忆功能下降程度更大。另外,hs-cTnT水平与整体认知、执行功能和运动速度下降相关。较高的NT-proBNP水平与脑微出血相关,而hs-cTnT水平与皮层梗死相关。在平均3年的随访期间,有26名(5.9%)患者死亡,有35名(8.1%)患者发生血管事件。较高的NTpro-BNP和hs-cTnT水平患者发生血管事件的风险增加,而较高的NT-proBNP和GDF-15水平患者死亡风险增加。

由此可见,基于血液的心脏生物标志物水平较高与记忆力下降以及血管事件和死亡风险相关。此外,NT-proBNP和hs-cTnT与脑微出血和皮层梗死有关。因此,这些生物标记物可潜在用于识别伴有不良血管事件和死亡风险的患者。

原始出处:

Bibek Gyanwali.et al.Blood-Based Cardiac Biomarkers and the Risk of Cognitive Decline, Cerebrovascular Disease, and Clinical Events.stroke.2021.https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.032571

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由此可见,腹部肥胖可能触发脑血管疾病病理过程,部分不依赖于血压,但与葡萄糖水平无关。这些病理过程的潜在靶标可能是卒中新的治疗机会。

Stroke:血浆含硫氨基酸与脑血管疾病风险的关系

这些结果表明蛋氨酸更高的生物利用度可能在预防脑血管疾病中起作用,并解释了之前已知的同型半胱氨酸与卒中之间的关系。

Lancet Neurology:2020新冠肆虐全球,脑血管疾病的重磅临床研究荟萃

2020新冠肆虐全球,脑血管疾病的重磅临床研究荟萃

Stroke:妊娠期脑卒中和脑血管疾病

由此可见,妊娠期卒中发病率上升,特别是产后期,其与妊娠期高血压疾病(尤其是先兆子痫)密切相关,这表明分娩后仍需要对重症高血压患者进行密切随访。