床旁联合检测NT-proBNP、cTnT、D-二聚体在心血管急症早期诊断中的价值

The Clinic Significance of Joint Bedside Assays of NT-pro BNP,c Tn T,D-dimmer in Early Phase Diagnosis of Patients with Cardiovascular Emergencies

目的观察床旁联合检测N末端B型脑钠肽原(NT-pro BNP)、心肌肌钙蛋白T(c Tn T)、D-二聚体在心血管急症早期诊断中的价值。方法入选2012年7月至2013年12月在我科就诊的以急性胸闷、胸痛、呼吸困难等为主要表现的心血管急症患者257例,随机分为常规组、快检组,另选2012年1月至6月在我科就诊的类似患者132例为对照组。比较3组患者入院初步诊断准确率差异和3组患者30天生存率差异,比较快检组与常规组快检时间差异。结果对照组、常规组及快检组入院诊断与出院诊断符合率分别为90.8%、97.6%、96.1%,快检组与常规组入院初步诊断准确率无差异(P>0.05),但快检组、常规组入院初步诊断准确率均显著高于对照组(均P<0.05);快检组床旁检测时间显著少于常规组送检验科检测时间(P<0.01);快检组与常规组患者30天生存率比较无差异(93.1%比92.2%,P>0.05),但均显著高于对照组30天84.1%的生存率(均P<0.05)。结论床旁联合检测NT-pro BNP、c Tn T、D-二聚体能准确而快速地协助心血管急症早期诊断,显著提高心血管急症患者生存率,值得推广。

Aim To explore the clinic significance of joint bedside assays of amino-terminal pro-B-type natriuretic peptide( NT-pro BNP),cardiac troponin T( c Tn T) and D-dimmer in early phase diagnosis of patients with cardiovascular emergencies. Methods From July in 2012 to December in 2013,we enrolled 257 patients who had clinic signs and symptoms of cardiovascular emergencies in cardiovascular department of our hospital,and they were randomized into regular assay group( n = 126) and quick assay group( n = 131); Moreover,from January to June in 2012 we enrolled 132 patients who had similar clinic signs and symptoms of cardiovascular emergencies and were admitted to hospital in our department as control group. We compared the accuracy rates of admitting diagnosis with discharge diagnosis among control group,regular assay group and quick assay group,and we also compared the 30-days survival rates among the three groups and the joint assay times of NT-pro BNP,c Tn T,D-dimmer between regular assay group and quick assay group. Results Compared the accuracy rates of admitting diagnosis with discharge diagnosis,the admitting diagnosis accuracy rate was90. 8%,97. 6%,96. 1% in control group,regular assay group and quick assay group respectively. The admitting diagnosis accuracy rates had no significance between the quick assay group and the regular assay group( P > 0. 05),and the admitting diagnosis accuracy rates were significantly higher in quick assay group and regular assay group than that in control group respectively( P < 0. 05). Moreover,the assay times in quick assay group were significantly shorter than that in regular assay group( P < 0. 01). The 30-day survival rates in quick assay group and regular assay group had no significance( P > 0. 05),but they were all significantly higher than that in control group( P < 0. 05). Conclusion The joint bedside assay of NT-pro BNP,c Tn T,D-dimmer should be popularized widely for its contributions to quick and accuracy admitting diagnosis and improvement of prognosis in patients with cardiovascular emergencies.