急性肺栓塞患者中N末端B型利钠肽前体水平升高的危险因素分析

Risk factors of elevated NT-proBNP level in patients with acute pulmonary embolism

目的:旨在探究急性肺栓塞(APE)患者中N末端B型利钠肽前体(NT-proBNP)水平升高的独立危险因素。方法:纳入2013年6月至2019年6月期间于中国医学科学院阜外医院血栓中心就诊的临床诊断为APE且具有冠脉CT检查(CCTA)的患者,记录患者入院时NT-proBNP水平、冠脉狭窄、Qanadli评分等临床指标,通过多因素logistic回归分析探究NT-proBNP升高的独立影响因素,通过Pearson相关性分析进一步探究各影响因素与NT-proBNP水平的相关性。结果:共纳入308例APE患者,男性124例(占40.3%),年龄(67±10)岁。其中,NT-proBNP≥500pg/mL患者118例,NT-proBNP<500pg/mL患者190例。多因素logistic回归分析结果显示,患者的心率[比值比(OR)1.030,95%可信区间(CI)1.011~1.050,P=0.002]、世界卫生组织(WHO)心功能分级Ⅲ级或Ⅳ级(OR 3.678,95%CI 1.280~10.572,P=0.016)、简化的肺栓塞严重指数(sPESI)评分≥1(OR 2.104,95%CI 1.080~4.102,P=0.029)、Qanadli评分(OR 1.021,95%CI 1.007~1.034,P=0.002)和冠脉狭窄(OR 1.832,95%CI 1.062~3.161,P=0.030)是影响NT-proBNP水平增高的独立危险因素,估算肾小球滤过率(eGFR)(简化MDRD公式)(OR 0.974,95%CI 0.959~0.990,P=0.001)是影响NT-proBNP水平增高的保护因素,且NT-proBNP水平与心率(ρ=0.250,P<0.001),Qanadili评分(相关系数ρ=0.207,P<0.001)和eGFR(ρ=-0.220,P<0.001)之间均存在较高的相关性。结论:临床上对于NT-proBNP水平升高的APE患者应关注其冠脉和肾功能状态。

Objective:To explore the independent risk factors of elevated NT-proBNP in acute pulmonary embolism.Methods:Patients hospitalized with acute pulmonary embolism and coronary computed tomography angioplasty(CCTA)in the Thrombus Center,Fuwai Hospital,from June 2013 to June 2019 were enrolled in the study.The clinical characteristics such as NT-proBNP level,coronary stenosis,Qanadli score and others were recorded.The influencing factors of elevated NT-proBNP were explored by multivariate logistic regression analysis,and the correlation between each influencing factor and NT-proBNP level was further explored by Pearson correlation analysis.Results:A total of 308 patients were enrolled in this analysis,with 124 males(40.3%)and age of(67±10)years.There were 118 patients with elevated NT-proBNP(≥500 pg/mL)and other 190 patients with NT-ProBNP<500 pg/mL.Multivariate logistic regression analysis showed that heart rate[odds ratio(OR)1.030,95%confidence interval(CI)1.011-1.050,P=0.002],World Health Organization(WHO)functional class Ⅲ or Ⅳ(OR 3.678,95%CI 1.280-10.572,P=0.016),simplified pulmonary embolism severity index(sPESI)score≥1(OR 2.104,95%CI 1.080-4.102,P=0.029),Qanadli score(OR 1.021,95%CI 1.007-1.034,P=0.002)and coronary stenosis detected by CCTA(OR 1.832,95%CI 1.062-3.161,P=0.030)were independent risk factors for increased NT-proBNP level in acute pulmonary embolism patients,while the estimated glomerular filtration rate(eGFR)calculated by the simplified MDRD formula(OR 0.974,95%CI 0.959-0.990,P=0.001)was a protective factor for the increased NT proBNP level.Pearson correlation analysis demonstrated moderate correlationship between NT-proBNP level and heart rate(ρ=0.250,P<0.001),Qanadli score(ρ=0.207,P<0.001)and eGFR(ρ=-0.220,P<0.001)were observed.Conclusion:More attention should be paid to the coronary stenosis and renal function of patients with acute pulmonary embolism and elevated NT-proBNP level in clinical practice.