肌钙蛋白Ⅰ、脑钠肽、心肌酶在右室功能障碍非高危肺栓塞的诊断价值

Diagnostic Value of Troponin Ⅰ,Brain Natriuretic Peptide and Myocardial Enzymes in Non-high Risk Pulmonary Embolism of Patients with Right Ventricular Dysfunction

目的评估肌钙蛋白Ⅰ(cTnⅠ)、脑钠肽(BNP)以及心肌酶谱预测右室功能障碍(RVD)非高危肺栓塞(PTE)的诊断价值。方法收集2013年01月01日~2017年05月01日196例疑诊PTE患者,排除47例(包括资料不全46例,血流动力学不稳定或休克者1例),有效病例149例,其中非高危PTE66例(RVD32例、non-RVD34例);非肺栓塞者(non-PTE)83例,入院24h内检测外周静脉血D-二聚体、CRP、心肌酶谱。结果两组年龄、BNP、乳酸脱氢酶(LDH)、羟丁酸脱氢酶、D-二聚体具有统计学差异(P<0.05),P值分别为0.021、0.002、0.013、0.016、0.019、0.034。非高危PTE的BNP、LDH、D-二聚体与non-PTE组指标相比具有统计学差异(P<0.05),P值分别为0.000、0.000、0.004、0.000。D-二聚体、BNP、LDH、羟丁酸脱氢酶预测非高危PTE的受试者操作曲线下面积依次为0.716(P=0.008)、0.724(P=0.006)、0.813(P=0.000)、0.685(P=0.024);BNP、LDH、羟丁酸脱氢酶与D-二聚体有相关性,相关系数依次为0.539(P=0.000)、0.330(P=0.001)以及0.297(P=0.002)。结论 D-二聚体、BNP、LDH、羟丁酸脱氢酶对确诊PTE有一定参考价值;疑诊PTE患者BNP水平达5 000 pg/m L左右水平时,需高度警惕RVD的存在,应尽快完善ECC和CTPA;LDH、羟丁酸脱氢酶可协助诊断RVD的非高危PTE。

Objective to evaluate the value of Troponin I （cT n l） , Brain natriuretic peptide（ BNP） and myocardial enzyme spectrum in predicting non-highrisk pulmonary embolism（PTE）of pa-tients with right ventricular dysfunction（RVD） .Methods 196 cases of suspected PTE from Janu-ary 1,2013 to May 1,2017 were collected and 149 cases were effective cases,excluding 47 ca- ses（including 46 cases of incomplete data and 1 case with hemodynamic instability or shock）. Among them, 66 cases were cases with non-high risk PTE （32 cases of RVD and 34 cases of non-RVD）and 83 cases of non-PTE.The peripheral venous blood D-dimer,CRP and myocardial enzymes were detected within 24h after admission.Results The difference of age,BNP,lactate dehydrogenase（LDH）, hydroxybutyrate dehydrogenase and D-dimer was statistically signifi- cant（P〈0.05,/〉 = 0.021,0.002,0.013,0.016,0.019,0.034）.There was a significant difference be-tween BNP,LDH and D-dimer in non-high risk PTE group and non-PTE group（P〈0.05,P = 0.000,0.000,0.004,0.000）.The D-dimer,BNP,LDH,and hydroxybutyrate dehydrogenase predic-ted AUROC（area under the curve）of non-highrisk PTE patients were 0.716（P=0.008） ,0.008（P = 0.006） ,0.813（P = 0.000） and 0.685（P = 0.024）.The correlation coefficients of BNP,LDH, hydroxybutyrate dehydrogenase and D-dimer were 0.539（P = 0.000）,0.330（P = 0.001） and 0.297（P=0.002）.Conclusion The D-dimer,BNP,LDH and hydroxybutyrate dehydrogenase have reference values in the diagnosis of PTE.If the BNP level of suspected PTE patients was about 5 000 pg/ml,we should maintain keen vigilance against RVD and improve ECC and CTPA. The LDH and hydroxybutyrate dehydrogenase can assist in the diagnosis of non-high risk PTE of patients with RVD