摘要
目的：探讨N端B型利钠肽原（NT-proBNP）对急性肺血栓栓塞症（PTE）患者的预后评估价值。方法：确诊为急性肺血栓栓塞症患者55例,以0~49岁NT-proBNP≥450 pg/ml,50~75岁NT-proBNP≥900 pg/ml,76~100岁NT-proBNP≥1 800 pg/ml为NT-proBNP（＋）组（n=31）,以0~49岁NT-proBNP〈450 pg/ml,50~75岁NT-proBNP〈900 pg/ml,76~100岁NT-proBNP〈1 800 pg/ml为NT-proBNP（-）组（n=24）。比较NT-proBNP（＋）组和NT-proBNP（-）组间体循环收缩压、心率、血氧分压、右心室舒张末期前后直径、肺动脉高压发生率、临床不良事件发生率的差异性,同时比较有无临床不良事件发生的患者NT-proBNP水平的差异。结果：NT-proBNP（＋）组较NT-proBNP（-）组心率增加显著（P〈0.05）,体循环收缩压和氧分压下降显著（P〈0.05）,差异均有统计学意义。超声心动图指标右心室舒张末期前后直径和肺动脉高压发生率均显著增加（P〈0.01）,临床不良事件发生率显著增加（P〈0.01）,差异均有统计学意义。共3例死亡,均发生在NT-proBNP（＋）组。有临床不良事件发生的患者（15例）NT-proBNP中位数7 436 pg/mL（140~45 720 pg/mL）比无临床不良事件发生患者（40例）的NT-proBNP中位数812 pg/mL（32~13 529 pg/mL）水平明显升高（P〈0.01）,差异有统计学意义,多元回归分析在校正了年龄、性别、高危PTE和中危PTE后,升高的NT-proBNP仍旧是发生临床不良事件的独立危险因素（比值比：15.3,95%可信限1.2~134.0,P〈0.05）。结论：高危和中危PTE患者多有血浆中NT-proBNP的水平升高,NT-proBNP的水平升高,提示预后不良。正常NT-proBNP的水平提示患者预后良好,NT-proBNP在PTE危险分层中起一定的作用。
Objective：To evaluate the prognostic value of NT-pro-B type natriuretic peptide（NT-proBNP） in patients with acute pulmonary thromboembolism（PTE）.Methods：A total of 55 PTE patients were divided into two groups.NT-proBNP（＋） group,n=31,the patients had the serum NT-proBNP≥450pg/ml from 0-49 years of age,NT-proBNP≥900pg/ml from 50-75 years,and NT-proBNP≥1800pg/ml from 76-100 years;and NT-proBNP（-） group,n=24,the patients had serum NT-proBNP less than the above level at each same age group respectively.The systolic blood pressure,heart rate,oxygen pressure（PaO2）,end diastolic diameter of right ventricle,rate of pulmonary hypertension and the clinical adverse outcome were compared in both groups.Results：The heart rate was increased and the systolic blood pressure,PaO2 were decreased in NT-proBNP（＋） group than that in NT-proBNP（-） group,P0.05 respectively.The end diastolic diameter of right ventricle and the rate of pulmonary hypertension were higher in NT-proBNP（＋） group,P0.01 respectively.The incidence of clinical adverse outcome was higher in NT-proBNP（＋） group,P0.01.The patients with clinical adverse outcome had the higher median NT-proBNP than those without it（7436pg/ml vs.812pg/ml）,P0.01.The elevated NT-proBNP was an independent risk factor for clinical adverse outcome by statistical analysis（OR：15.3,95% CI 1.2~134.0;P 0.05）.Conclusion：The patients with the high risk or intermediate risk of PTE usually have increased serum NT-proBNP,likewise,PTE patients with normal serum level of NT-proBNP will have better prognosis.
出处
《中国循环杂志》
CSCD
北大核心
2010年第6期460-463,共4页
Chinese Circulation Journal
关键词
肺血栓栓塞症
N端B型利钠肽原
预后
Pulmonary thromboembolism
NT-pro-B type natriuretic peptide
Prognosis
