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Objective To determine the value of using B-type natriuretic peptide (BNP) and D-dimer in preliminary recognition of cardioembolic stroke patients.Methods A mutilple-center study was conducted in Foshan Hospital of traditional Chinese Medicine (TCM) and its affiliated hospitals from July 2015 to July 2016.In the emergency departments (EDs),emergency physicians prospectively assessed consecutive adult patients with acute cardioembolic stroke and measured plasma BNP by POCT platform on admission,then followed up.Stroke neurologists evaluated patients' functional outcome at hospital discharge and also made discharge diagnosis and stroke etiologic subtypes according to the TOAST criteria.Results In this study,290 acute ischemic stroke patients met the study criteria [mean age (68.41 ± 12.06) years;53.8％ female].Of the enrolled patients,28.3％ were diagnosed with LAA at discharge,17.9％ with CE,42.8％ with SAO,11.0％ with SOE or SUE.And the mean BNP concentration was significantly higher in the CE group than that in other three subtypes (P ＜ 0.001).After adjustment for multiple clinical predictors like gender,age,coronary artery disease,atrial fibrillation and renal function,BNP and D-dimer were associated with CE [BNP OR:1.044 (95％ CI 1.025,1.064),P ＜ 0.001;D-dimer OR:1.511(95％ CI 1.020,2.238),P =0.039,respectively].Conclusion Through POCT technique in the EDs,cardioembolic stroke patients can be differentiated from other TOAST subtypes.BNP with/without D-dimer has good but different corresponding diagnostic performance in preliminary recognition of cardioembolic stroke patients.
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Objective To investigate the serum osteoprotegerin (OPG) levels in patients with acute ischemic stroke and evaluate the relation of serum OPG levels with stroke severity,focus size and stroke subtypes according to TOAST criteria.Methods The study consisted of 62 patients with acute cerebral infarction (patient group) and 40 control subjects (control group),collected in our hospital from August 2010 to January 2011.The patient group was sub-divided into large artery atherosclerotic stroke (LAA) group (n=26) and small artery occlusive or lacunar stroke (SAA) group (n=36) in terms of TOAST criteria.Clinical data and examination results were collected.Serum OPG levels were measured with enzyme linked immunoadsorbent assay (ELISA).Results Serum OPG levels in patients with acute ischemic stroke were significantly higher than those in control subjects (P＜0.05); Logistic regression analysis showed that hypertension (P=0.004) and serum OPG levels (P=0.002) exhibited significant correlations with presence of acute cerebral infarction; serum OPG levels were correlated with NIHSS scores (r=0.658,P=0.000) and maximum diameter of the focus (r=0.487,P=0.010) in ischemic stroke group; serum OPG levels in LAA subgroup were significantly higher than those in SAA subgroup and control group (P＜0.05),and there was no significant difference of serum OPG levels between SAA subgroup and control group (P=0.086).Conclusions Serum OPG levels may play roles in presence of acute ischemic stroke as independent risk factors.OPG levels are related to the severity of illness and focus size,and especially associated with LAA stroke subtype.
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Objective To explore the relationship between gene polymorphism of neuropeptide Y (NPY) promoter and cerebral stroke subtypes according to TOAST (Trail of ORG 10172 in Acute Stroke Treatment) criteria in Chinese Han population. Methods The gene polymorphisms at position of-399T/C, -883Tgins/del and -602G/T in NPY promoter were detected by PCR method and gene sequencing in 190 cases of large-artery atherosclerosis stroke (LAA), 260 cases of small-artery occlusion (SAO), 60 cases of cardioembolism stroke (CE), 29 cases of stroke of other demonstrated etiology (ODE),10 cases of stroke of other undemonstrated etiology (UE) and 423 healthy control subjects. The PCR products were directly sequenced. Multivariate logistic regression was performed to analyze the relationship between gene polymorphism of NPY promoter and cerebral stroke subtypes according to TOAST by removing the confounding variables. Results Significant differences in the frequency of genotype CC and allele C at position of-399T/C were noted between the patients with SAO and controls (P=0.046, P=0.010). Compared with the control group, patients with LAA and SAO were more likely having high level of uric acid, hypertension, diabetes mellitus and heard disease (P＜0.05). No statistic differences in the frequency of genotype DD and allele D at position of-883Tgins/del were noted between patients with SAO and controls (P=0.0605, P=0.155). Gene polymorphisms of-399T/C,-883Tgins/del and -602G/T did not associate with an increased risk of having LAA, CE, ODE and UE.Conclusions The gene polymorphisms of promoter in position of-399T/C gene maybe associate with the happening of SAO; allele C at the position of-399T/C may raise the risk of the disease. There is no relationship between the gene polymorphisms of promoter at position of-399T/C, -883Tgins/del, -602G/T and the patients with LAA, CE, ODE and UE. High level of uric acid, hypertension, diabetes mellitus and heard disease history are the risk factors of LAA and SAO.