B型利钠肽对急性肺栓塞预后预测价值的Meta分析

Prognostic Value of B-Type Natriuretic Peptide in Acute Pulmonary Embolism:A Meta-Analysis

目的探讨B型利钠肽(B-type natriuretic peptide,BNP)对急性肺栓塞(acute pulmonary embolism,APE)患者短期全死因死亡的预测价值。方法计算机检索PubMed、EMbase、Cochrane图书馆临床对照试验资料库、CBM网络版和CNKI等数据库,检索时间均从建库至2010年3月,收集BNP和N-终端前BNP(N-terminal pro-B-type natriuretic peptide,NT-proBNP)水平升高对APE患者预后影响的队列研究,对符合纳入标准的临床研究进行质量评价和资料提取后,采用RevMan 5.0和MetaDisc软件进行Meta分析。结果共纳入16项研究,合计1126例患者。9个研究报道了BNP水平,7个研究报道了NT-proBNP水平,各组间异质性较小(P=0.94,I2=0;P=0.99,I2=0),且无临床异质性,故将BNP或NT-proBNP升高视为同一结果。Meta分析结果显示:BNP或NT-proBNP水平升高对于短期全死因死亡预测价值的SEN合并为0.89,SPE合并为0.52,+LR合并为1.87,-LR合并为0.20,PPV为0.16,NPV为0.98,SROC曲线下面积为0.8305,SE(AUC)=0.0335。结论 BNP水平升高可以帮助鉴别死亡率高的急性肺栓塞患者,而BNP水平正常的患者阴性预测值高则有助于医生识别出那些不良事件发生可能性较低的患者,以便有选择性地进行患者随访。

Objective To investigate the prognostic value of B-type natriuretic peptide（BNP） for short-term all-cause mortality in patients with acute pulmonary embolism（APE）.Methods Such databases as PubMed,EMbase,Central Register of Controlled Trials,CBM,and CNKI（from the date of their establishments to March 2010） were searched.The level of BNP and N-terminal pro-B-type natriuretic peptide（NT-proBNP） was collected to conduct eligible cohort study for assessing their effects on APE prognosis.Quality assessment and data extraction were performed in those clinical trials in line with the inclusion criteria.Then,RevMan 5.0 software was applied to carry out meta-analyses.Results Sixteen relevant studies with 1126 APE patients were included.Nine studies reported BNP level and seven studies reported NT-pro BNP level.There was less satistical and clinical Heterogeneity among the groups（P=0.94,I2=0;P=0.99,I2=0）.The meta-analyses results showed：the BNP or NT-pro BNP level was closely related with the short-term all-cause mortality.SPE was 0.52,＋ LR was 1.87,–LR was 0.20,PPV was 0.16,NPV was 0.98,SROC area under the curve was 0.830 5,SE（AUC） =0.0335.Conclusion While elevated BNP levels can help to identify APE patients at a higher risk of death,the high negative predictive value of normal BNP levels is more useful for doctors to identify patients with less likelihood of adverse events so as to conduct a selective follow-up.