BNP和cTnI联合检测在急性肺栓塞致右心功能不全评估中的临床应用

Clinical application of joint detection of BNP and cTnI in the evaluation of right heart insufficiency caused by acute pulmonary embolism

目的探讨血浆脑钠肽(brain natriuretic peptide,BNP)和心肌肌钙蛋白(cTnI)联合检测在急性肺栓塞(acute pulmonary embolism,APE)致右心功能不全评估中的临床应用价值。方法对2009年8月—2011年8月收治的APE患者采用BNP和cTnI联合检测,对其右心室功能障碍进行评估,为临床APE的诊断、有针对性的治疗及预后判断提供理论依据。结果右心功能不全组和无右心功能不全组BNP和cTnI水平比较,差异均有统计学意义(t=42.14和33.64,均P<0.01)。BNP>100 pg/ml或(和)cTnI>0.05 ng/ml的患者右心功能不全的发生率(100.00%)明显高于BNP≤100pg/ml或(和)cTnI≤0.05 ng/ml的患者右心功能不全的发生率(30.00%),且差异有统计学意义(χ2=18.34,P<0.05)。相关性研究结果显示,右心功能不全组与BNP、cTnI均呈显著相关性(OR值分别为38.95和31.05,95%CI=6.65%～48.57%和6.40%～130.12%),其差异均有统计学意义(P<0.05)。对BNP和cTnI 2个指标进行综合考虑时,BNP升高或cTnI升高且出现右心功能不全者20例,占全部右心功能不全的90.91%。BNP与cTnI水平与右心功能不全有显著的相关性(r=0.92)。结论在APE的发病过程中,血BNP和cNTI浓度的变化与右心功能不全具有良好的相关性,BNP联合cTnI可以作为临床评估APE患者发生右心功能不全的有效方法,为临床APE的诊断、有针对性的治疗及预后判断提供理论依据。

[ Objective ] To explore the clinical value of joint detection of brain natriuretic peptide （ BNP ） and cTnI in the evaluation of right heart insufficiency caused by acute pulmonary embolism [ APE）. [ Methods ] APE patients who have visited the hospital from August 2009 to August 2011 were given the joint detection of BNP and cTnI, and the right ventricular dysfunction was evalua- ted, so as to provide a theoretical basis for APE diagnosis, treatment and prognosis judgement. [ Results ] There were significant differences in levels of BNP and cTnI between right ventricular dysfunction group and non-right ventricular dysfunction group {t =42.14 and 33.64,both P 〈0. Ol }. The incidence rate of right ventricular dysfunction in patients with BNP 〉 100 pg/ml or （and} cTnI 〉0.05 ng/ml （ 100.00% ） was higher than that in patients with BNP~〈100 pg/ml or {and） ethic〈0.05 ng/ml, and the difference was significant （ X2 = 18.34, P 〈 0.05 ）. The correlation analysis showed that the right ventricular dysfunction had signifieant correlation with BNP level and eTnI level （OR value was 38. 95 and 31.05 respectively, 95% CI = 6.65%- 48.57% and 6. 40% -130.12% ） , and the differences were significant （ P 〈 O. 05 ）. The overall evaluation of BNP and cTnI 2 found that there were 20 right heart insufficiency patients with higher BNP level or higher cTnI level, which accounted for 90.91% of total right heart insufficiency patients. There was a significant correlation between the levels of BNP and cTnI and right heart insufficien- cy （ r = O. 92 }. [ Conclusion ] During the process of APE, there is a significant correlation between the change of BNP and cTnI lev- els and right heart insufficiency. The joint detection of BNP and cTnI can be used as an effective method for the evaluation of right heart insufficiency caused by APE, which provide a theoretical basis for APE diagnosis, treatment and prognosis judgement.