肺栓塞患者血清N末端脑钠肽前体、D-二聚体、内皮素1水平变化及临床意义

Changes in levels of serum NT-Pro BNP,D-dimer and ET-1 in patients with pulmonary thromboembolism and their clinical significance

目的探讨肺栓塞患者血清N末端脑钠肽前体(NT-Pro BNP)、D-二聚体、内皮素1(ET-1)水平变化及其与病情、预后的关系。方法四川省凉山彝族自治州第二人民医院收治的95例急性肺血栓栓塞患者及50例健康成年人,分别纳入肺栓塞组及对照组。肺栓塞组患者进行危险度分层,分为高危组(18例)、中危组(43例)及低危组(34例),测定受试者血清NT-Pro BNP、D-二聚体、ET-1水平。结果①与对照组比较,肺栓塞组血清NT-Pro BNP、D-二聚体、ET-1水平升高(P<0.05);高危组血清NT-Pro BNP、D-二聚体、ET-1水平高于中危组、低危组,中危组患者各指标水平高于低危组(P<0.05)。②入组患者好转出院85例,死亡10例,死亡组血清NT-Pro BNP、D-二聚体、ET-1水平高于存活组(P<0.05)。③治疗后,肺栓塞患者血清NT-Pro BNP、D-二聚体、ET-1水平均降低(P<0.05)。④血清NT-Pro BNP、D-二聚体、ET-1水平预测患者死亡的曲线下面积为0.832、0.810、0.751,血清NT-Pro BNP预测效能最高,当其截点值为1145.07 pg/ml时,约登指数最大,此时诊断敏感度及特异度分别为100%、60.00%。⑤NT-ProBNP联合D-二聚体、NT-ProBNP联合ET-1、D-二聚体联合ET-1及三者联合预测肺血栓患者预后的曲线下面积分别为0.907、0.882、0.845、0.916,其中三者联合预测价值最高。结论肺血栓栓塞患者伴有血清NT-Pro BNP、D-二聚体、ET-1水平的升高,且其水平与患者病情严重程度及预后相关,临床可将单独或联合用于预测患者预后。

Objective To explore the changes in levels of serum N-terminal pro-brain natriuretic peptide(NT-Pro BNP),D-dimer(D-D)and endothelin-1(ET-1)in patients with pulmonary thromboembolism(PTE)and their relationship with disease and prognosis.Methods Ninety-five patients with acute PTE who were admitted to the Second People's Hospital of Liangshan Yi Autonomous Prefecture and 50 healthy adults were enrolled as study objects.They were included into PTE group and control group,respectively.The PTE group was further divided into high-risk group(n=18),moderate-risk group(n=43)and low-risk group(n=34).The levels of serum NT-Pro BNP,D-D and ET-1 were measured.Results①Compared with the control group,levels of serum NT-Pro BNP,D-D and ET-1 were increased in the PTE group(P<0.05).Levels of serum NT-Pro BNP,D-D and ET-1 in the high-risk group were higher than those in the intermediate-risk group and the low-risk group and levels of the indicators in the intermediate-risk group were higher than those in the low-risk group(P<0.05).②In the patients,85 were improved and discharged,and 10 cases died.Levels of serum NT-Pro BNP,D-D and ET-1 in the death group were significantly higher than those in the surviving group(P<0.05).③After treatment,levels of serum NT-Pro BNP,D-D and ET-1 in patients with pulmonary embolism were significantly reduced(P<0.05).④Areas under the ROC curve(AUC)of serum NT-Pro BNP,D-D and ET-1 for predicting death were 0.832,0.810 and 0.751,respectively.The predictive efficiency of serum NT-Pro BNP was the highest when its cut-off value was 1145.07pg/ml,in which the Yoden index was the largest and diagnostic sensitivity and specificity were 100%and 60.00%,respectively.⑤The AUC for prognosis of patients with pulmonary thrombosis were 0.907,0.882,0.845 and 0.916 when NT-ProBNP was combined with D-D,NT-ProBNP was combined with ET-1,D-D was combined with ET-1,and the three indicators were combined.hree indicators combined have the highest combined predictive value.Conclusion PTE patients are accompanied with increased levels of serum NT-Pro BNP,D-D and ET-1.Their levels are related to disease severity and prognosis.Clinically,they can be applied alone or in combination as reference indexes.