急性肺栓塞患者右心功能不全诊断指标的比较分析

A comparative study on diagnostic indexes for right ventricular dysfunction in patients with acute pulmonary embolism

目的比较血压、脑钠肽(BNP)、肺动脉收缩压(PASP)对急性肺栓塞(APE)患者右心功能不全(RVD)的诊断价值。方法回顾性分析84例经CT肺动脉造影确诊的APE病例。根据心脏超声分为有RVD组和无RVD组。以18个临床及辅助检查变量为研究因素,RVD为相关因素,经Logistic回归模型评估RVD与以上研究因素的关系。通过受试者工作特征(ROC)曲线分析BNP、PASP对RVD的预测价值。结果有RVD组心率快于无RVD组,舒张压、平均动脉压高于无RVD组,BNP>100 pg/ml者比率大于无RVD组,PASP>40 mm Hg者比率大于无RVD组(均P<0.05)。Logistic回归模型显示BNP>100 pg/ml(OR=4.904,95%CI 1.431～16.806,P=0.011)和PASP>40 mm Hg(OR=6.415,95%CI 1.509～27.261,P=0.012)与RVD相关。BNP诊断RVD的ROC曲线下面积为0.823(95%CI 0.729～0.917),PASP诊断RVD的ROC曲线下面积为0.798(95%CI 0.700～0.896)。结论血压相关参数不能作为RVD的预测指标。联合检测APE患者BNP及PASP有助于准确预测RVD。

Objective To explore and compare the diagnostic value of blood pressure, brain natriuretic peptide （BNP）, pulmonary artery systolic pressure （PASP） in evaluating right ventricular dysfunction （RVD） in patients with acute pulmonary embolism （APE）. Methods A retrospective study was conducted on 84 APE patients who were diagnosed by computed tomographic pulmonary angiography. The patients were divided into a RVD group and a non-RVD group by echocardiography. Eighteen clinical and auxiliary examination variables were used as the research factors and RVD as the related factor. The relationship between these research factors and RVD were evaluated by logistic regression model, the diagnostic value of BNP and PASP to predict RVD was analyzed by receiver-operating characteristic （ROC） curve analysis. Results The patients with RVD had more rapid heart rate, higher diastolic blood pressure, higher mean arterial pressure, higher incidence of BNP〉100 pg/ml and higher incidence of PASP〉40 mm Hg （all P〈0.05）. Upon logistic regression model, BNP〉 100 pg/ml （OR=4.904, 95%CI 1.431-16.806, P=0.011） and PASP〉40 mmHg （OR=6.415, 95%CI 1.509-27.261, P=0.012） were independent predictors of RVD. The areas under the ROC curve to predict RVD were 0.823 （95%CI 0.729-0.917） for BNP, and 0.798 （95%CI 0.700-0.896） for PASP. Conclusions Blood pressure related parameters can not serve as a predictor of RVD. Combined monitoring of BNP level and PASP is helpful for accurate prediction of RVD in patients with APE.