右心声学造影联合血清cTnI、NT-proBNP对心源性脑梗死的预测价值

摘要 目的：探讨右心声学造影联合血清心肌肌钙蛋白I（cTnI）、N-末端脑利钠肽前体（NT-proBNP）对心源性脑梗死（CE）的预测价值。方法：选择2020年7月至2023年6月湖南中医药高等专科学校附属第一医院收治的急性脑梗死患者128例，根据是否发生CE分为CE组（n=31）和非CE组（n=97）。两组均行右心声学造影检查，检测两组血清cTnI、NT-proBNP水平，比较两组右心声学造影参数及血清cTnI、NT-proBNP水平。受试者工作特征（ROC）曲线分析右心声学造影联合血清cTnI、NT-proBNP对CE的预测价值。结果：右心声学造影显示CE组卵圆孔未闭阳性率、右向左分流分级（1级+2级+3级）构成比、卵圆孔长径均显著高于非CE组（P<0.05）。CE组卵圆孔未闭患者活动性房间隔构成比显著高于非CE组卵圆孔未闭患者（P<0.05）。CE组血清cTnI、NT-proBNP水平显著高于非CE组。ROC曲线分析结果显示，卵圆孔未闭、右向左分流分级1级+2级+3级、卵圆孔长径、活动性房间隔、cTnI、NT-proBNP对CE具有一定的预测价值，其中联合检验对CE的预测效能最高，曲线下面积（AUC）为0.867（0.812～0.928）。结论：右心声学造影联合血清cTnI、NT-proBNP检查可用于CE的预测。

Predictive Value of Right Heart Contrast Echocardiography Combined with Serum cTnI and NT-proBNP for Cardiogenic Cerebral Infarction

ABSTRACT Objective: To investigate the predictive value of right heart contrast echocardiography combined with serum cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) for cardiogenic cerebral infarction (CE). Methods: 128 patients with acute cerebral infarction who were admitted to the The First Affiliated Hospital of Hunan College of Traditional Chinese Medicine from July 2020 to June 2023 were selected, patients were divided into CE group (n=31) and non CE group (n=97) according to the occurrence of CE. Both groups underwent right heart contrast echocardiography, the levels of serum cTnI and NT-proBNP were detected in two groups, the parameters of right heart contrast echocardiography and the levels of serum cTnI and NT-proBNP were compared between two groups. The predictive value of right heart contrast echocardiography combine with serum cTnI and NT-proBNP for CE were analyzed by receiver operating characteristic (ROC) curve. Results: Right heart contrast echocardiography showed that the positive rate of patent foramen ovale, the proportion of right-to-left shunt (grade1+grade2+grade3), and the long diameter of foramen ovale in CE group were significantly higher than those in non CE group (P<0.05). The proportion of active atrial septum in patients with patent foramen ovale in CE group were significantly higher than those in non CE group (P<0.05). The levels of serum cTnI and NT-proBNP in CE group were significantly higher than those in non CE group. ROC curve analysis showed that, patent foramen ovale, right-to-left shunt grade1+grade2+grade3, patent foramen ovale length and diameter, active atrial septum, cTnI and NT-proBNP had certain predictive value for CE, the combined test had the highest predictive efficiency for CE, and the area under the curve (AUC) was 0.867 (0.812~0.928). Conclusion: Right heart contrast echocardiography combined with serum cTnI and NT-proBNP can predict CE.