Stroke：N-端脑钠肽和肌钙蛋白T与无症状脑梗死及脑白质病灶独立相关

脑血管病与心血管病有很多相同的危险因素。来自休斯顿的Razvan T. Dadu等学者研究了N-端脑钠肽(NT-proBNP)与心脏高敏肌钙蛋白T(hs-cTnT)与脑血管病间的关系，在线发表在2013年5月9日Stroke杂志上。该文章目的是研究N-端脑钠肽(NT-proBNP)与心脏高敏肌钙蛋白T(hs-cTnT)是否与社区动脉粥样硬化危险因素研究(ARIC)显示的MRI无症状脑梗死(BIs)和脑白质病灶(WMLs)相关，结果显示：N-端脑钠肽和肌钙蛋白T与无症状脑梗死及脑白质病灶独立相关。
在ARIC研究中第三次(1993–1995)数据采集中，1920例患者进行脑MRI检查。在ARIC研究第四次数据采集中(1996–1998)对所有1920例患者进行NT-proBNP和hs-cTnT的检查，其中1112例患者在2004–2006年中进行随访MRI检查。研究分析了NT-proBNP和hs-cTnT与初次MRI定义的BI和WML和随访的BI和WML的变化，纳入的患者排除心衰、冠心病和卒中病史。
在调整后的模型中，高NT-proBNP四分位数含量与基线数据时BI数量（优势比为3.5,95%的可信区间为2.03-6.20）级WML（β系数为0.09; SE为0.03）相关，与随访MRI显示的BI增加（优势比为2.18,95%可信区间为1.38-3.47）和WML进展(β系数为0.22; SE为 0.10)相关。高hs-cTnT含量与基线时MRI检查BI数量增加（优势比为3.03,95%可信区间为1.57-5.82）和WML进展（β系数为0.11; SE为0.04）相关，与随访MRI显示的更多WML进展(β系数为0.43; SE为0.17)相关。
NT-proBNP和hs-cTnT与MRI显示的无症状脑梗死及脑白质病灶独立相关，这显示心血管病的生物标记物在识别亚临床脑损伤方面有重要作用。

Cardiovascular Biomarkers and Subclinical Brain Disease in the Atherosclerosis Risk in Communities Study.
BACKGROUND AND PURPOSE
Cerebrovascular and cardiovascular disease share common risk factors. Our goal was to determine whether levels of N-terminal brain natriuretic peptide (NT-proBNP) and cardiac troponin T measured with a highly sensitive assay (hs-cTnT) are associated with silent brain infarcts (BIs) and white matter lesions (WMLs) on MRI in the Atherosclerosis Risk in Communities (ARIC) study.
METHODS
At ARIC visit 3 (1993-1995), 1920 participants had brain MRI. NT-proBNP and hs-cTnT were measured in all individuals at ARIC visit 4 (1996-1998). Of 1920 individuals, 1112 had a follow-up MRI [2004-2006]). We analyzed the association of NT-proBNP and hs-cTnT with MRI-defined BI and WML on the initial MRI and incident BI and WML progression on the follow-up MRI in participants without heart failure, coronary heart disease, or stroke.
RESULTS
In the adjusted model, individuals in the highest NT-proBNP quartile had significantly more BI (odds ratio, 3.50; 95% confidence interval, 2.03-6.20), and WML (β-coefficient, 0.09; SE, 0.03) on the baseline MRI and more incident BI (odds ratio, 2.18; 95% confidence interval, 1.38-3.47) and WML progression (β-coefficient, 0.22; SE, 0.10) on the follow-up MRI. Individuals in the highest hs-cTnT category had more BI (odds ratio, 3.03; 95% confidence interval, 1.57-5.82) and WML (β-coefficient, 0.11; SE, 0.04) on the initial MRI and more WML progression (β-coefficient, 0.43; SE, 0.17) on the follow-up MRI.
CONCLUSIONS
NT-proBNP and hs-cTnT are independently associated with silent MRI-defined BI and WML, suggesting that cardiovascular biomarkers may be useful to identify individuals with subclinical cerebral injury.