急性肺栓塞患者血浆B型钠尿肽水平的变化及意义

Changes and significance of blood B-type natriuretic peptide in patients with acute pulmonary embolism

目的 探讨血浆B型钠尿肽（BNP）对急性肺栓塞患者危险分层、治疗方案选择以及预后评估的临床意义.方法 入选2013年3月至2014年3月在山西省临汾市人民医院住院诊治并确诊的急性肺栓塞患者52例.入院时均行BNP、心脏超声检查.依据2001年中华医学会呼吸病学分会的肺血栓栓塞症的诊断与治疗指南（草案）将患者分为大面积肺栓塞、次大面积肺栓塞和非大面积肺栓塞3组.根据超声心动图检查结果分为右心室功能不全组与右心室功能正常组.观察住院期间患者不良事件发生率及不同分组患者BNP和右心室功能变化.结果 大面积肺栓塞组及次大面积肺栓塞组患者BNP浓度明显高于非大面积肺栓塞组患者[（795 ±22）、（408 ±21）ng/L比（86±17）ng/L] （P ＜0.01）;右心室功能不全组BNP明显高于右心室功能正常组[（675±36）ng/L比（392 ±23） ng/L] （P＜0.05）;右心室功能不全组不良事件发生率明显高于右心室功能正常组[64.7％（11/17）比34.3％ （12/35）]（P＜0.05）.结论 患者发病时血浆BNP浓度越高,病情越严重,临床不良事件发生率越高.右心室功能及BNP联合检查能更好地预测住院期间急性肺栓塞患者不良事件的发生.提示BNP及右心室功能对急性肺栓塞患者危险分层有重要的临床指导意义,并可作为判断预后的风险因子.

Objective To explore the clinical significance of blood B-type natriuretic peptide （BNP） for risk stratification,treatment and prognostic evaluation in patients with acute pulmonary embolism.Methods Totally 52 consecutive patients with acute pulmonary embolism from March 2013 to March 2014 were enrolled.The concentration of blood BNP was measured and the right ventricular function was detected by echocardiography after admission.The patients were classified into massive,sub-massive and non-massive pulmonary embolism group;in addition,the patients were divided into right ventricular normal function group and right ventricular dysfunction group based on the results of echocardiography.Results The BNP concentration in massive and sub-massive pulmonary embolism group were both higher than that in non-massive pulmonary embolism group [（795 ± 22）,（408 ± 21） ng/L vs （86 ± 17） ng/L] （P 〈 0.01）,and was significantly higher in right ventricular dysfunction group than that in right ventricular normal function group [（675 ± 36） ng/L vs （392 ± 23） ng/L] （P 〈 0.05）.The incidence of adverse events in right ventricular dysfunction group was significantly higher than that in right ventricular normal function group [64.7% （11/17） vs 34.3 % （12/35）] （P 〈 0.05）.Conclusion In patients with acute pulmonary embolism,higher BNP level is,assoiated with the serions condition and more incidence of adverse events;BNP combined with right ventricular function has important value for risk stratification acute pulmonary embolism.