脑钠肽对急性肺栓塞患者右心功能不全的预测价值

Predictive value of brain natriuretic peptide for right ventricular dysfunction in patients with acute pulmonary embolism

目的探讨急性肺栓塞(APE)患者血浆脑钠肽(BNP)水平对右心功能不全(RVD)的预测价值。方法入选经64层螺旋CT确诊的APE患者82例,记录一般资料。入院24 h内抽血检测BNP,同时进行超声心动图检查评估右心功能。根据BNP水平将患者分为高BNP组36例和低BNP组46例。超声心动图评估右心功能参数包括舒张末期右心室与左心室横径比(RV/LV)、右室面积变化率(RVFAC)、肺动脉收缩压(PASP)、三尖瓣环收缩期位移(TAPSE)、右心室心肌做功指数(RV-Tei)。对2组患者一般临床资料及超声心动图参数进行统计学分析。结果高BNP组晕厥、心源性休克、超声心动图示RVD发生率及心率(HR)、RV/LV、RV-Tei、PASP均明显高于低BNP组(P均<0.05),血压(BP)、RVFAC、TAPSE均明显低于BNP组(P均<0.05)。多变量Logistic回归分析显示,BNP是预测RVD的独立危险因素(OR=4.992,95%CI[1.132,18.999],P=0.018)。BNP水平预测APE患者发生RVD的ROC曲线下面积为0.785,95%CI[0.638,0.932](P<0.05),最佳预测值为110.7 pg/mL。BNP与RV-Tei呈正相关(r=0.712,P<0.05),与TAPSE呈负相关(r=-0.603,P<0.05)。结论血浆BNP水平升高是RVD的可靠标志,可以早期应用于APE患者临床不良预后的预测,为APE患者选择更加妥善的诊疗方案提供参考。

Objective It is to investigate the predictive value of brain natriuretic peptide(BNP)for right ventricular dysfunction in patients with acute pulmonary embolism(APE).Methods 82 patients with APE diagnosed by 64-slice spiral CT were enrolled and their general information was recorded.Blood was taken for BNP detection within 24 hours of admission,and echocardiography was performed to assess right heart function.The patients were divided into high BNP group(n=36 cases)and low BNP group(n=46 cases)according to BNP level.Echocardiographic assessment of right heart function parameters included:right ventricular and left ventricular aspect ratio(RV/LV),right ventricular Fractionalarea change(RVFAC),pulmonary artery systolic pressure(PASP),tricuspid annulus peak systolic displacement(TAPSE),right ventricular myocardial work index(RV-Tei).Statistical analysis was performed on the general clinical data and echocardiographic parameters of the two groups of patients.Results The incidence of syncope,cardiogenic shock,and echocardiographic RVD,heart rate,RV/LV,RV-Tei,PASP were significantly higher,while blood pressure,RVFAC,TAPSE were significantly lower in the high BNP group than those in the low BNP group(P<0.05).The Logistic regression analysis showed that BNP was the strongest independent predictor for predicting RVD(OR=4.992,95%CI[1.132,18.999],P=0.018).The area under the ROC curve was 0.785,95%CI[0.638,0.932](P<0.05)in the prediction of RVD in patients with APE,and the best predictive value was 110.7 pg/mL.There was a positive correlation between BNP and RV-Tei(r=0.712,P<0.05)and a negative correlation between BNP and TAPSE(r=-0.603,P<0.05).Conclusion The increase of plasma BNP level is a reliable marker of RVD and can be used early in the prediction of clinically poor prognosis in patients with APE.It provides a reference for patients to choose more stable treatment plan and improve prognosis.