急性肺血栓栓塞症患者出院前复查D-二聚体和N-末端B型利钠肽原的临床价值

Clinical value of D-dimer and N-terminal B-type natriuretic peptide reexamination before discharge in patients with acute pulmonary thromboembolism

目的:探讨急性肺血栓栓塞症(PTE)患者出院前复查血浆D-二聚体和N-末端B型利钠肽原(NT-proBNP)的临床价值。方法:根据出院前血浆D-二聚体和NT-proBNP水平,将200例PTE患者分为D-二聚体和NT-proBNP水平恢复正常组(n=122)和D-二聚体和NT-proBNP水平持续升高组(n=78)。于出院后3个月、6个月、12个月及之后每年1次对两组患者进行随访,评估复发PTE的发生情况。结果:升高组心率失常例数高于正常组(P<0.05);两组年龄、体质指数、性别、发病时间、合并高血压、高血脂症及伴深静脉血栓栓塞比较,差异无统计学意义(P>0.05);升高组PTE复发事件高于正常组(P<0.05)。单因素和多因素Cox回归分析表明,血浆D-二聚体和NT-proBNP水平升高与PTE复发有关,是PTE复发的预测因子。结论:出院前血浆D-二聚体和NT-proBNP水平升高的急性PTE患者,PTE复发的风险相对较高,应适当延长抗凝治疗时间。

Objective:To evaluate the clinical value of plasma D-dimer and N-terminal B-type natriuretic peptide(NT-proBNP)in patients with acute pulmonary thromboembolism(PTE)before discharge.Methods:A total of 200 patients with acute pulmonary thromboembolism according to the plasma D-dimer and NT-proBNP levels before discharge,the patients were divided into the group whose plasma D-dimer and NT-proBNP levels recovered to normal before discharge(normal group,n=122)and the group whose plasma D-dimer and NT-proBNP levels continued to increase before discharge(increased group,n=78).The patients in the two groups were followed up at 3m,6m,12m and once a year to evaluate the incidence of recurrent PTE.Results:The number of arrhythmias in the increased group was significantly higher than that in the normal group(P<0.05),but there were no significant differences in age,body mass index,gender,onset time,hypertension,hyperlipidemia and deep vein thrombosis(P>0.05).PTE recurrence events in the increased group were higher than those in the normal group(P<0.05).Univariate and multivariate Cox regression analysis showed that increased plasma D-dimer and NT-proBNP levels were associated with PTE recurrence and were predictors of PTE recurrence.Conclusion:Before discharge,the plasma D-dimer and NT-proBNP levels of acute PTE patients with increased anticoagulation after the end of the standard anticoagulation course,the risk of PTE relapse increased,for such patients should be appropriately extended anticoagulation treatment time.