心电学及生物标志物在急性肺栓塞诊疗中的价值探讨

Utility of dynamic ECG and biomarkers for diagnosis of acute pulmonary embolism

目的探讨心电学及生物标志物动态变化在急性肺栓塞诊疗和风险评估中的价值。方法回顾性分析近5年住院确诊的17例急性肺栓塞患者不同阶段的心电学特点及动态变化,结合D二聚体(D-D)、肌钙蛋白I(c Tn I)、B型脑利钠肽前体(Pre-BNP)、C反应蛋白(CRP)等生化指标进行分析比较。结果 1入院时心电图变化主要包括SⅠ>0.1 m V者9例,SⅠQⅢTⅢ者4例,a VR终末呈R波者10例,胸前导联T波倒置6例,窦性心动过速6例,完全/或不完全性右束支阻滞者2例。有效治疗后心率下降、心前区导联T波演变、TⅢ倒置变浅或转直立、QⅢ减小或消失,a VR终末R波振幅下降,QTcd降低。23例死亡病例SⅠ、QⅢTⅢ、avR终末R波以及广泛心前区导联T波倒置发生比率明显增高。死亡患者较存活病例QTcd明显增大[(80.2±34.5)ms/(74.8±33.7)ms]。3生物标志物DD(78.6%)、Pre-BNP(64.3%)、LDH(64.3%)、CK-MB(50.0%)升高最为常见。4死亡组DD、Pre-BNP和肌钙蛋白I/T的异常升高发生率均为100%,明显高于存活组。结论分析心电学及其动态变化,并结合血生物标志物,对急性肺栓塞的诊断、疗效评估、危险分层、预后判断具有十分重要的参考价值。

Objective To explore the clinic value of the dynamic changes of electrocardiology and biological markers in the diagnosis,treatment,and risk assessment of acute pulmonary thromboembolism. Methods Seventeen patients with acute pulmonary thromboembolism in recent 5 years were recruited in this study. The characteristics and dynamic change of electrocardiology as well as the biomarkers including D-D,c Tn I,Pre-BNP,and CRP were measured,analyzed and compared during different period in hospital. Results ① The electrocardiologic changes observed on the admission included as follows： 9 patients with SⅠ 0. 1 mv,4 patients with SⅠ,QⅢTⅢ,pattern,10 patients with terminal showing R wave in lead a VR,6 patients with T-wave inversion in precordial leads,6 patients with sinus tachycardia,and 2 patients with complete / incomplete right bundle branch block. After effective treatment,obvious ECG changes were observed in patients including the decrease in heart rate,the evolution of T wave in precordial leads（ the transfer of T wave inversion to shallow and positive）,reduction or disappear of QIII,decrease in the amplitude of terminal R wave in lead a VR,and decrease in the value of QTcd. ② The occurrence rate of SⅠ,QⅢTⅢ,terminal R wave in a VR,as well as extensive T-wave inversion in precordial leads was significantly elevated in 3 patients. The value of QTcd in died patients was significant higher than that in survived patient[（ 80. 2 ± 34. 5） ms vs.（ 74. 8 ± 33. 7） ms],P〈0. 05）. ③ Blood biomarkers were elevated in patients as follows： DD（ 78. 6%）,Pre-BNP（ 64. 3%）,LDH（ 64. 3%）,and CK-MB（ 50. 0%）. ④ The blood DD,Pre-BNP,and I / T were all elevated in all died patients and was significantly higher than that in the survival group. Conclusion The dynamic monitoring of electrocardiology and blood biomarkers is valuable in the diagnosis,treatment,risk assessment,and prognosis judgment of patients with acute pulmonary thromboembolism.