B型钠尿肽水平变化在急性肺栓塞患者中的临床意义

Clinical significance of B type natriuretic peptide levels in patients with acute pulmonary embolism

目的探讨B型钠尿肽（BNP）检测对急性肺栓塞患者进行危险分层和心功能不全的临床意义。方法入选2012年1月-2014年1月于广东省惠州市中心人民医院住院诊治并确诊的急性肺栓塞患者78例。入院时均行BNP、心脏超声检查。将患者分为大面积肺栓塞（28例）、次大面积肺栓塞（18例）、非大面积肺栓塞（32例）三组。据超声心动图结果分为右心功能不全组与右心功能正常组;观察住院期间患者不良事件发生率及不同分组患者BNP和右心功能变化。结果大面积肺栓塞[（792.36±132.76）pg/mL]、次大面积肺栓塞[（528.89±101.36）pg/mL]与非大面积肺栓塞[（187.35±38.36）pg/mL]血浆BNP浓度比较差异有统计学意义（P〈0.05）。右心功能不全组与右心功能正常组间BNP浓度比较,差异有统计学意义[（682.76±162.28）pg/mL比（392.43±86.76）pg/mL,P〈0.05];右心功能不全组不良事件发生率高于右心功能正常组,差异有统计学意义[62.5%（25/40）比31.6%（12/38）,P〈0.05]。Pearson积矩相关分析发现,大面积肺栓塞、次大面积肺栓塞、非大面积肺栓塞和血浆BNP浓度变化呈正相关,差异有统计学意义（r=0.791,P〈0.05）。心功能分级与血浆BNP浓度变化呈负相关,差异有统计学意义（r=-0.812,P〈0.05）。结论患者发病时血浆BNP值越高,病情越严重,临床不良事件发生率越高。大面积肺栓塞、次大面积肺栓塞、非大面积肺栓塞和血浆BNP浓度变化呈正相关,心功能分级与血浆BNP浓度变化呈负相关。

Objective To analyze clinical significance of B type natriuretic peptide（BNP） for risk stratification and cardiac insufficiency in patients with acute pulmonary embolism. Methods Seventy eight cases of patients with acute pulmonary embolism hospitalized and confirmed in Huizhou Municipal Central Hospital from January 2012 to January 2014 were enrolled. The blood BNP and cardiac uhrasonography of all patients was detected after admission. Patients were classified into massive（28 cases）, sub-massive（18 cases）, non-massive pulmonary embolism（32 cases）. According to the results of echocardiography, the patients were divided into right ventricular normal function group and right ventricular dysfunction group. The incidence of adverse reactions and the changes of BNP and right ventricular function in different groups during hospital stay were observed. Results There were statistically significant differences of BNP concentration among comparison of different groups in massive pulmonary embolism [（792.36 ±132.76） pg/mL], sub-massive pulmonary embolism [（528.89±101.36） pg/mL] and no-massive pulmonary embolism[（187.35±38.36） pg/mL]（P 〈0.05）. There was a statistically significant difference in right ventricular dysfunction group and right ventricular normal function group [（682.76±162.28） pg/m L vs（392.43±86.76） pg/mL, P 〈0.05]. The incidence of adverse reactions in right ventricular dysfunction group was higher than that in right ventricular normal function group [62.5%（25/40） vs 31.6%（12/38）, P〈 0.05]. Pearson product correlation analysis showed that massive pulmonary embolism, sub-massive pulmonary embolism, no pulmonary embolism were positively correlated with plasma BNP concentrations, the difference was statistically significant（r = 0.791, P 0.05）. Cardiac function classification was negatively correlated with plasma BNP concentrations, the difference was statistically significant（r =-0.812, P 〈0.05）. Conclusion When the patients are on set, the higher the serum BNP value is, the more serious conditions are, the higher the incidence of key clinical events is. The massive pulmonary embolism, sub-massive pulmonary embolism, no pulmonary embolism are positively correlated with plasma BNP concentrations. Cardiac function classification is negatively correlated with plasma BNP concentrations.