肺动脉压和脑钠肽对静脉血栓导致肺栓塞的预测价值

Prediction value of venous thrombosis leading to pulmonary embolism caused by pulmonary artery pressure and brain natriuretic peptide

目的探讨当下肢深静脉血栓,螺旋CT肺血管成像无法完成检查时,通过经胸壁超声心动图测定肺动脉多项指标,血液检查脑钠肽及心肌酶的数值,评估其对急性肺动脉栓塞预测的价值。方法选88例APE住院治疗患者为病例组,90名健康体检者为对照组。根据病例组肌钙蛋白、肌红蛋白、BNP数值,病例组分为中危组与低危组;对照组为无肺栓塞组。以CTPA为肺栓塞诊断依据,比较3组人群TTE、BNP及心肌酶水平,绘制受试者工作特征曲线。结果急性肺动脉栓塞中危组与对照组比较,肺动脉压、BNP差异具有统计学意义(P<0.05),其中肺动脉压(OR=0.751,95%CI=0.646~0.881,P<0.001)、BNP(OR=0.957,95%CI=0.931~0.985,P=0.003);ROC曲线图得到肺动脉压AUC=0.900(95%CI=0.842~0.958)、BNP AUC=0.896(95%CI=0.826~0.966),根据约登指数得出,最佳截断值肺动脉压为33mmHg,BNP为47.52pg/mL。结论肺动脉压与脑钠肽极有可能是下肢深静脉血栓并发急性肺栓塞的独立预测因素,可视为预测急性肺动脉栓塞的重要参考依据。

Objective To measure the pulmonary artery pressure multiterm index by transthoracic echocardiography(TTE),brain natriuretic peptide and numerical value of myocardial enzymes were tested by blood,when spiral CT pulmonary angiography(CTPA)could not completed the examination of deep venous thrombosis(DVT)of lower extremities,to evaluate the predict value of the methods for acute pulmonary embolism(APE).Methods 88 hospitalized patients with APE were selected as case group and 90 healthy people with physical examination as control group.According to the values of troponin,myoglobin and BNP,the case group was divided into intermediate-risk and low-risk groups;The control group was the group without pulmonary embolism.Based on CTPA,the levels of TTE,BNP and myocardial enzyme in the three groups were compared,and the operating characteristic curve was drawn.Results There were statistically significant differences in pulmonary artery pressure and BNP between the middle-risk group and the control group(P<0.05),pulmonary artery pressure(OR=0.751,95%CI=0.646~0.881,P<0.001)and BNP(OR=0.957,95%CI=0.931~0.985,P=0.003).The ROC curve showed that pulmonary artery pressure AUC=0.900(95%CI=0.842~0.958)and BNP AUC=0.896(95%CI=0.826~0.966).According to Jordon index,the optimal cut-off value of pulmonary artery pressure was 33mmHg and BNP=47.52pg/mL.Conclusions Pulmonary artery pressure and brain natriuretic peptide are most likely independent predictors of deep vein thrombosis of lower extremity complicated with acute pulmonary embolism,and can be considered as important references for predicting acute pulmonary embolism.