B型钠尿肽对次大面积肺血栓栓塞症危险分层、治疗及预后评估的临床意义

Clinical Significance of BNP for Risk Stratification, Treatment and Prognosis in Submassive PTE

目的:探讨B型钠尿肽(BNP)不同水平在次大面积肺血栓栓塞症(PTE)的危险分层、治疗方案选择及预后评估中的临床意义。方法:根据血浆BNP水平将84例次大面积PTE患者分为2组:A组BNP>90ng/L50例,B组BNP≤90ng/L34例。根据治疗方法的不同,A、B组各自再分为溶栓并抗凝组和单纯抗凝组。分析BNP与患者临床症状、体征、心电图、血气分析、超声心动图及预后的关系。结果:A组与B组在呼吸困难和胸痛等临床表现、动脉血氧分压和氧合指数等血气分析指标、心电图、右心扩大和肺动脉收缩压(PASP)等超声心动表现的差异有统计学意义(P<0.05或P<0.01);A组与B组在治疗后12个月内预后的差异有统计学意义(P<0.05或P<0.01);A组内溶栓并抗凝组与单纯抗凝组在肺动脉压改善(△PASP)、显效或好转率及预后的差异有统计学意义(P<0.05或P<0.01);B组内2亚组间的临床指标改善及并发症发生率的差异无统计学意义(P>0.05)。结论:BNP的检测有助于对次大面积PTE患者进行高危筛查和预后评估,对治疗方案的选择具有重要的临床价值。

Objective： To explore the clinical significance of B-type natfiuretic peptides（BNP）for risk stratification, treatment and prognosis in submassive pulmonary thremboembolism （PTE）. Methods： A total of 84 patients with confirmed submassive PTE were divided into two groups according to plasma BNP levels, including group A （n=50）, BNP〉90 ng/L and group B （n=34）, BNP≤90 ng/L. Meanwhile, patients in group A and group B were respectively divided into two sub-groups according the treatment： thrembolysis combined with anticoagulant therapy or simple anticoagulant therapy. The clinical fea- ture, electrocardiogram （ECG）, blood gas analysis, echocardiography and the prognosis were analyzed and compared in ENP patients. Results：There were statistical significant differences in dyspnea, chest pain and the clinical manifestation, arterial partial pressure of oxygen, oxygenation index and the blood gas analysis, ECG, the right heart expansion, pulmonary artery sys- tolic pressure （PASP） and the echocardiography findings between group A and group B （P 〈 0.05 or P 〈 0.01）. There were sig- nificant differences in the clinical prognosis within 12 months after the treatment between group A and group B （P 〈 0.05 or P 〈 0.01）. There were significant differences in the improvement of PASP（ A PASP）, cure or improved rate and the clinical prognosis between two sub-groups according to the treatment： thrombolysis combined with anticoagulant therapy or simple an- ticoagulant therapy of group A （P 〈 0.05）. There were no significant differences in the improvement of the clinical manifesta- tion and the complication rate between two sub-groups of group B （P 〈 0.05）. Conclusion：The detection of plasma BNP con- tributes to the high-risk screening and prognostic assessment of submassive PTE, and has clinical significance for selecting the treatment scheme as well.