血浆B型尿钠肽对急性肺栓塞患者的预后价值探讨

摘要

目的:探讨B型尿钠肽(B-type natriuretic peptide,BNP)对急性肺栓塞患者的预后价值.方法:以本院98例急性肺栓塞患者为研究对象,定量检测血浆BNP水平,随访至出院后6个月,分析BNP水平变化与急性肺栓塞患者危险分层和预后的关系,患者所有临床数据资料均应用SPSS 19.0软件进行统计学分析处理.结果:与BNP水平正常的患者相比,BNP升高的患者发生休克、低氧血症等不良临床事件及死亡的比例明显升高.ROC曲线分析表明:血浆BNP水平<226.5 ng/L的急性肺栓塞患者的生存率明显高于血浆BNP水平>226.5 ng/L的患者(P=0.000).结论:检测急性肺栓塞患者血浆BNP能在患者入院早期阶段较准确地预测患者的不良预后,有利于患者的危险分层以及指导进一步的治疗决策.%Objective To investigate prognostic value of B-type natriuretic peptide (BNP) in acute pulmonary embolism (APE) by observing the plasma level of BNP in APE patients. Methods We measured the plasma level of BNP at the time of admission to determine their utility in prognosticating the clinical course of 98 consecutive patients with APE. The relationship between these values and adverse outcomes or death of the patients was evaluated. All analyses were performed with SPSS 19.0 software. Results In all the APE patients,56(57.1%) patients had the level of BNP above the upper limit of normal (100 ng/L),42 (42.9%) patients had the normal level. The patients with the elevated BNP had an increased risk of adverse outcomes, such as shock and hypoxemia as compared with those normal level. And the mortality of the patients with the elevated BNP is higher than the patients with normal levels. A receiver-operating characteristic curve analysis identified BNP > 226.5 ng/L as the best cut-off value(AUC 0.829, 95% CI 0.715 ~ 0.942) with the negative predictive value of 97.1% and positive predictive value of 41.4% for the death of the patients. Kaplan-Meier survival curves assessed the relevance of BNP value and APE-related death,and BNP > 226.5ng/L was associated with increased risk for APE-related death. Conclusions BNP values in patients with APE at admission accurately identifies patients at risk for APE-related adverse outcomes or death in the early stage. We demonstrated the usefulness of BNP in risk stratification and treatment of APE patients.