急性肺栓塞溶栓疗效及溶栓前后NT-proBNP的变化

The therapeutic efficacy of thromblysis and NT-proBNP changes in patients with acute pulmonary embolism

目的:观察瑞替普酶对急性肺栓塞(APE)患者溶栓治疗的临床疗效及溶栓前后血浆N端B型尿钠肽前体(NT-proBNP)水平的变化及其临床意义。方法:42例符合溶栓治疗条件的APE患者给予瑞替普酶18mg+18mg静脉溶栓治疗,分别观察溶栓前及溶栓6h后患者临床表现、血浆NT-proBNP、肌钙蛋白T(cTnT)水平,溶栓12～24h复查超声心动图、CT肺动脉成像或核素肺灌注显像,评价临床疗效。结果:血管再通患者37例(88.1%),其NT-proBNP浓度和肺动脉压力均较溶栓前显著下降[(8 672.4±201.7)pg/ml︰(1 559.8±23.5)pg/ml,(52.82±17.34)mmHg︰(38.13±12.32)mmHg,1mmHg=0.133kPa;均P<0.01)],且NT-proBNP浓度下降幅度与肺动脉压下降幅度、右心室/左心室比值密切相关(r分别为0.61、0.54);溶栓前后cTnT水平差异无统计学意义。血管未通患者5例,其溶栓前后NT-proBNP、cTnT及肺动脉压力差异无统计学意义。结论:瑞替普酶对APE患者进行静脉溶栓治疗有较好的临床疗效和安全性,且动态检测NT-proBNP浓度可作为评价溶栓再灌注成功与否的有效指标。

Objective：To evaluate the efficacy of thrombolytic therapy with reteplase,and investigate the clinical significance of detecting N terminal pro brain natriuretic peptide（NT-proBNP） changes in patients with acute pulmonary embolism（APE）. Method：Forty two patients with documented APE recieved thrombolytic therapy with reteplase.Clinical manifestations,plasma NT-proBNP and cardiac troponin T（cTnT） levels were monitored before and 6 h after thrombolytic therapy.Echocardiography and pulmonary CT angiography or radionuclide lung perfusion imaging were performed to evaluate the therapeutic efficacy 12-24 h after thrombolytic therapy. Result：Thirty seven patients（88.1%） exhibited significant angiographic reperfusion after thrombolytic therapy.NT-proBNP level and mean pulmonary arterial pressure decreased significantly in all of them [（8 672.4±201.7）pg/ml︰（1 559.8±23.5）pg/ml,（52.82±17.34）mmHg︰（38.13±12.32）mmHg,1 mmHg=0.133 kPa;both P〈0.01）].Plasma NT-proBNP levels had a positive correlation with pulmonary arterial pressure and RV/LV ratio（r=0.61,0.54）.There was no significant variation in cTnT levels after thrombolytic therapy.While there was no significant improvement in levels of NT-proBNP,cTnT and pulmonary arterial pressure in five failed thromblysis patients after thrombolytic therapy. Conclusion：Thrombolytic therapy with reteplase is effective and safe for APE.Serial measurements of NT-proBNP could be used as a effective indicator to assess the success or failure of the thrombolytic treatment.