N-末端脑钠肽前体联合超声心动图对急性肺栓塞患者预后的评估

Value of N-terminal pro-B-type natriuretic peptide combined with echocardiogram in evaluation of prognosis in patients with acute pulmonary embolism

目的探讨N-末端脑钠肽前体(NT-pro BNP)和右心功能在急性肺栓塞(APE)患者中的变化,研究其在APE患者临床预后的评估作用。方法收集2010~2014年在河南科技大学第一附属医院住院,临床诊断为APE的患者135例。根据超声心动图检查结果将APE患者分为右心功能正常组(71例)、右心功能不全组(64例);根据APE住院期间是否发生死亡、病情恶化及不良事件将APE患者分为预后良好组(81例)、预后不良组(54例)。分析不同组别主要临床指标的差异,得出影响APE患者预后的因素。结果右心功能不全组不良事件、死亡的发生率与右心功能正常组比较,差异有统计学意义(P<0.05),右心功能不全组高于右心功能正常组;与右心功能正常组比较,右心功能不全组NT-pro BNP、c Tn I及Pa O2差异有统计学意义(P<0.05);预后不良组NT-pro BNP、c Tn I水平与预后良好组比较,差异有统计学意义(P<0.05),预后不良组高于预后良好组。Logistic逐步回归分析结果显示:右心功能不全、NT-pro BNP、c Tn I、深静脉血栓病史与APE患者住院期间预后不良相关,OR∧值分别为8.503、5.474、5.418和5.084。结论 NT-pro BNP与右心功能不全呈正相关,二者均是APE患者预后的预测因子,结合后的评估价值更大。

Objective To explore the value of N-terminal pro-B-type natriuretic peptide(NT-pro BNP) combined with echocardiogram in the evaluation of prognosis in patients with acute pulmonary embolism(APE). Methods One hundred and thirty-five patients with APE admitted to the First Affiliated Hospital of Henan University of Science and Technology from 2010 to 2014 were retrospectively analyzed. All APE patients were divided into normal right ventricular function group(71 cases) and right ventricular dysfunction group(64 cases) according to echocardiographic results, and into favorable prognosis group(81 cases) and poor prognosis group(54 cases) according to whether there was occurrence of main adverse events. The NT-pro BNP and other clinical indexes were analyzed statistically to obtain the factors influencing the prognosis of APE patients. Results The rates of adverse events and death in the right ventricular dysfunction group were higher than those in the normal right ventricular function group(P < 0.05).Compared with the normal group, the levels of NT-pro BNP, c Tn I and Pa O2 in the right ventricular dysfunction group increased(P < 0.05). The levels of NT-pro BNP and c Tn I in the poor prognosis group were higher than those in the favorable prognosis group(P < 0.05). Logistic regression analysis showed that right ventricular dysfunction, NT-pro BNP, c Tn I and history of deep vein thrombosis were related to poor prognosis of inhospital patients( O R∧= 8.503,5.474, 5.418 and 5.084 respectively). Conlusions NT-pro BNP and right ventricular dysfunction are positively correlated, both are the independent predictors of prognosis of APE patients, and the combination of the two has greater value in assessment of patients' prognosis.