血浆N末端B 型利钠肽原和心肌肌钙蛋白I对急性肺栓塞合并右心功能障碍患者病情评估的临床价值

摘要

目的:探讨血浆N末端B型利钠肽原 (NT-proBNP) 和心肌肌钙蛋白I ( cTnI) 对急性肺栓塞合并右心功能障碍患者病情评估的临床价值 .方法:选取急性肺栓塞患者92例,根据超声心动图检查结果将所有患者分为两组:合并右心功能障碍组47例和不合并右心功能障碍组45例.入院后次日即采取空腹静脉血,应用免疫荧光法测定血浆NT-proBNP和cTnI水平,并在确诊急性肺栓塞24 h后行超声心动图检查.结果:合并右心功能障碍组血浆NT-proBNP、cTnI水平及右心室舒张末期内径均高于不合并右心功能障碍组,两组比较差异均有统计学意义(P均<0.01).受试者工作特征曲线分析发现:NT-proBNP和cTnI的曲线下面积均大于90%,最佳阈值分别是554 pg/ml和0.09 ng/ml.Logistic 逐步回归分析结果显示:NT-proBNP(r=1.227,P=0.005)、cTnI(r=0.862, P=0.016)、右心功能障碍(r=0.936,P=0.008)、心率(r=0.809,P=0.023)与急性肺栓塞患者住院期间预后不良相关.结论:血浆NT-proBNP和cTnI水平有助于诊断急性肺栓塞合并右心功能障碍,并能很好地预测近期临床转归.%Objective: To explore the clinical value of N-terminal Pro-brain natriuretic peptide (NT-ProBNP) and cardial troponin I (cTnI) for evaluating the patients with acute pulmonary embolism (APE) combining right ventricular dysfunction (RVD). Methods: A total 92 APE patients treated in our hospital were studied. The blood levels of NT-ProBNP and cTnI were measured on next morning of administration and echocardiography was performed within 24 hours of APE diagnosis. According to echocardiographic results, the patients were divided into 2 groups: APE with RVD group,n=47 and APE without RVD group,n=45. Blood levels of NT-ProBNP and cTnI were compared between 2 groups. Results: Compared with APE without RVD group, APE with RVD group presented increased levels of NT-ProBNP, cTnI and right ventricular end-diastolic diameter (RVEDD), allP<0.01. ROC curve analysis found that both AUC of NT-ProBNP and cTnI > 90%, the optimum operating point for NT-ProBNP and cTnI were 554 pg/ml and 0.09 ng/ml respectively. Logistic regression analysis showed that NT-ProBNP (r=1.227,P=0.005), cTnI (r=0.862,P=0.016), right ventricular dysfunction (r=0.936,P=0.008) and heart rate (r=0.809,P=0.023) were related to poor prognosis for in-hospital patients. Conclusion: Blood levels of NT-ProBNP and cTnI may help diagnosing the patients with acute pulmonary embolism with right ventricular dysfunction, it may also predict the short term prognosis in clinical practice.