N-末端脑钠肽前体在肺血栓栓塞症诊治中的临床意义

Clinical significance of plasma N-terminal pro-brain natriuretic peptide in diagnosis and treatment of pulmonary thromboembolism

目的探讨N-末端脑钠肽前体(NT-proBNP)在肺血栓栓塞症(PTE)诊治中的临床意义。方法选择2005年1月至2010年8月在北京安贞医院住院诊治的急性肺血栓栓塞症患者26例、慢性血栓栓塞性肺动脉高压手术治疗患者32例、慢性血栓栓塞性肺动脉高压药物治疗11例分别作为急性组、慢性手术组、慢性药物组,观察他们治疗前后血浆N-末端脑钠肽前体浓度的变化。同期选择年龄、性别相匹配的健康者30名作为对照组。血浆N-末端脑钠肽前体浓度采用酶联免疫吸附法检测。结果急性组、慢性手术组、慢性药物组血浆NT-proBNP浓度分别为(2579±2026)ng/L、(3206±2529)ng/L和(2914±2211)ng/L,明显高于对照组的(350±240)ng/L(均P<0.01);急性组有效治疗后、慢性手术组有效治疗后血浆NT-proBNP浓度分别为(461±325)ng/L和(727±664)ng/L,均明显低于治疗前水平(P<0.05);慢性药物组无效治疗后血浆NT-proBNP为(3365±3244)ng/L,和治疗前相比差异无显著性(P>0.05)。结论肺血栓栓塞症患者血浆NT-proBNP浓度升高,有效治疗后其浓度下降。观察血浆NT-proBNP浓度变化可能有助于PTE的诊断和疗效评估。

Objective To investigate the clinical significance of plasma N-terminal pro-brain natriuretic peptide（NT-proBNP） in diagnosis and treatment of pulmonary thromboembolism（PTE）.Methods From January 2005 to August 2010,the plasma NT-proBNP levels of 26 patients with acute PTE（acute group）,32 patients with chronic thromboembolic pulmonary hypertension（chronic surgery group） and 11 patients with chronic thromboembolic pulmonary hypertension（chronic medicine group） in Beijing Anzhen Hospital before and after treatment were measured.In the meantime,30 healthy people were enrolled as control group.Plasma NT-proBNP concentrations were determined by enzyme-linked immunosobent assay（ELISA）.Results The plasma NT-proBNP levels of acute group,chronic surgery group and chronic medicine group were（2579±2026）ng/L,（3206±2529）ng/L and（2914±2211）ng/L respectively,which were all higher than（350±240）ng/L of control group（all P0.01）.The plasma NT-proBNP levels of acute group and chronic surgery group after effective treatment were（461±325）ng/L and（727±664）ng/L separately,which were lower than those of the two group before treatment（all P0.05）.Compared with those before management,（3365±3244）ng/L of chronic medicine group after failed treatment was not statistically different（P0.05）.Conclusion The plasma NT-proBNP levels in patients with PTE are high,which may decrease in effective treatment.It is helpful for the diagnosis and effectiveness evaluation of PTE to observe the changes of plasma NT-proBNP concentrations.