D-二聚体、BNP及血气分析在急性肺栓塞诊断及病情评估中的临床价值

Clinical value of D-dimer,BNP and blood gas analysis in the diagnosis and disease evaluation of acute pulmonary embolism

目的探讨联合检测急性肺栓塞患者的血浆D-二聚体、B型尿钠肽水平及动脉血气指标PaO_2在临床急性肺栓塞诊断及病情评估中的应用价值。方法选取经肺动脉CTA确诊的急性肺栓塞患者28例,依据PaO_2水平分为PaO_2>60 mm Hg肺栓塞组和PaO_2≤60 mm Hg肺栓塞组,另选择本院同期健康体检的30例为健康对照组。测定各组患者血浆D-二聚体水平、B型尿钠肽水平及动脉血气指标PaO_2结果。结果肺栓塞组的血浆D-二聚体、B型尿钠肽两者联合检测的灵敏度为96.42%,健康对照组特异度为80.00%;肺栓塞组中,PaO_2≤60 mm Hg组血浆D-二聚体、BNP水平均明显高于PaO_2>60 mm Hg组,组间差异有统计学意义(P<0.01);两组肺栓塞组患者血浆D-二聚体、BNP水平均高于健康对照组,差异有统计学意义(P<0.01)。结论血浆D-二聚体、BNP、血气分析联合应用对急性肺栓塞患者诊断、危险分层及预后判断中具有一定的临床意义。

Objective To evaluate the application value of the combined determination of plasma D-dimer, B-type na- triuretic peptide level and arterial blood gas index（PaO2） in the clinical diagnosis and evaluation of acute pulmonary embolism in patients with acute pulmonary embolism. Methods A total of 28 patients with acute pulmonary embolism who were diagnosed by pulmonary artery CTA were selected. According to PaO2 levels, they were divided into PaO2〉60 mmHg pulmonary embolism group and PaO2 ≤60 mmHg pulmonary embolism group. Another 30 healthy subjects re- ceiving physical examination in the same hospital were selected as the heahhy control group. The levels of plasma D- dimer, B-type natriuretic peptide and arterial blood gas index PaO2 were measured in each group. Results The sensi- tivity of combined determination of plasma D-dimer and B-type natriuretic peptide in pulmonary embolism group was 96.42%, and the specificity in the healthy control group was 80.00%; in the pulmonary embolism group, plasma D- dimer and BNP levels in PaO2≤60 mmHg group were significantly higher than those in PaO2〉60 mmHg group. There was significant difference between the two groups（P〈0.01 ）; the levels of plasma D-dimer and BNP in the pulmonary embolism group were higher than those in the healthy control group,, and the difference was statistically significant （P〈0.01）. Conclusion The combined use of plasma D-dimer, BNP, and blood gas analysis shows a certain clinical sig- nificance in the determination of diagnosis, risk stratification and prognosis in the patients with acute pulmonary em- bolism.