急性肺栓塞患者血浆肌钙蛋白Ⅰ、脑钠肽和右心功能的变化

Changes of plasma troponinⅠ,brain natriuretic peptide and right ventricular function in patients with acute pulmonary embolism

目的：探讨血浆肌钙蛋白Ⅰ、脑钠肽和右心功能检测对急性肺栓塞患者的临床意义。方法选择2009年6月至2014年6月收治的急性肺栓塞患者70例，依据患者超声心动图检测结果，将患者分为右心功能障碍组32例和未见右心功能障碍组38例。对两组患者的临床表现、临床不良事件及预后情况进行比较分析，并探讨 cTnⅠ和 BNP 水平与右心功能的相关性。结果与未见右心功能障碍组急性肺栓塞患者相比，右心功能障碍组患者呼吸困难表现率明显提高，差异有统计学意义（χ^2=18.57，P〈0.01）；晕厥临床表现率明显提高，差异有统计学意义（χ^2=4.27，P〈0.05）。与未见右心功能障碍组急性肺栓塞患者相比，右心功能障碍组患者不良事件溶栓治疗、低血压休克、机械通气以及心肺复苏率均明显较高，差异有统计学意义（χ^2=4.66，4.28，5.01，5.53；P〈0.05）；cTnⅠ和 BNP 水平均明显提高，差异有统计学意义（t =14.67，16.57；P〈0.01）。结论急性肺栓塞患者血浆中肌钙蛋白Ⅰ、脑钠肽水平和右心功能情况对患者病情危险分层的评估具有十分重要的指导作用。

Objective To investigate the clinical significance of plasma troponinⅠ,brain natri-uretic peptide and right heart function in patients with acute pulmonary embolism. Methods From June 2009 to June 2014,70 patients with acute pulmonary embolism were selected. According to the results of echocardiography test,the patients were divided into right ventricular dysfunction group（ n = 32）and without right ventricular dysfunction group（n = 38）. The clinical manifestations,clinical adverse events and prognosis of the patients between the two groups were compared. And the relationship between cTnⅠ,BNP levels and right ventricular function were investigated. Results Compared with without right ventricular dysfunction group,in right ventricular dysfunction group,the incidence of dyspnea increased significantly,the difference was significant（χ^2 = 18. 57,P〈 0. 01）,the incidence of syncope increased significantly,the difference was significant（ χ^2 = 4. 27,P〈 0. 05）. Compared with without right ventricular dysfunction group,in right ventricular dysfunction group,the incidences of adverse events thrombolytic therapy,hypotension,mechanical ventilation and cardiopulmonary resuscitation in-creased significantly,the differences were significant（χ^2 = 4. 66,4. 28,5. 01,5. 53;P〈 0. 05）. The levels of cTn and BNP increased significantly in right ventricular dysfunction group,the differences were significant（t = 14. 67,16. 57;P〈 0. 01）. Conclusions Troponin Ⅰ,brain natriuretic peptide in plasma and right heart function has very important role in guiding for disease risk stratification assessment for patients with acute pulmonary embolism.