氨基末端B型利钠肽前体与D-二聚体和肌钙蛋白I在急性肺栓塞患者中的应用价值

目的探讨氨基末端B型利钠肽前体(NT-proBNP)与D-二聚体(D-Dimer)和肌钙蛋白I(cTnI)在急性肺栓塞(APE)患者中的应用价值。方法回顾性分析145例经肺动脉CT血管造影确诊的APE患者,同时行超声心动图、NT-proBNP、cTnI、D-Dimer检查,排除可能影响NT-proBNP、cTnI、D-Dimer浓度的疾病。根据肺栓塞危险分层分为高危组、中高危组、中低危组、低危组。结果血浆NT-proBNP浓度在高危组、中高危组、中低危组均显著高于低危组(P<0.05),NT-proBNP与肺栓塞危险分层呈正相关(r=0.618,P<0.05),单独检测可用于预测右心室功能不全,最佳截断值为1305 ng/L,敏感性和特异性分别为69.2%和69.9%(AUC=0.751,95%CI:0.672~0.819,P<0.05)。D-Dimer浓度在高危组、中高危组、中低危组与低危组间差异均无统计学意义(P>0.05),D-Dimer浓度与危险分层无相关性(r=0.078,P>0.05),预测右心室功能不全的效能较差(AUC=0.569,95%CI:0.485~0.651,P>0.05)。cTnI浓度在高危组、中高危组、中低危组均高于低危组(P<0.05),与危险分层呈正相关(r=0.303,P<0.05),预测右心室功能不全的最佳截断值为0.20μg/L,敏感性和特异性分别为82.7%和40.9%(AUC=0.655,95%CI:0.571~0.732,P<0.05)。联合检测NT-proBNP、cTnI预测右心室功能不全(RVD)效能优于单独检测(AUC=0.778,95%CI:0.701~0.842,P<0.05)。结论血浆NT-proBNP、cTnI水平随着危险分层增加而升高,对于鉴别APE患者是否合并RVD有一定价值,可用于肺栓塞患者的危险分层、预后判断。D-Dimer浓度与肺栓塞危险分层无相关性,预测RVD效能较差。

Clinical value of NT-proBNP,D-Dimer and cTnI in patients with acute pulmonary embolism

Objective To evaluate clinical value of NT-proBNP,D-Dimer,cTnI in patients with pulmonary embolism.Methods A total of 145 cases who were diagnosed acute pulmonary embolism by CT pulmonary angiography accepted examinations of echocardiography,NT-proBNP,cTnI and D-Dimer were retrospectively investigated.Diseases that might affect NT-proBNP,cTnI,D-Dimer were excluded.Patients were divided into 4 groups by risk stratification,high-risk group,medium high-risk group,medium low-risk group and low-risk group.Results Plasma NT-proBNP levels were significantly higher in high-risk group,medium high-risk group,medium low-risk group than low-risk group(P<0.05).NT-proBNP level positively correlated with risk stratification(r=0.618,P<0.05),and predicted right ventricular dysfunction in APE(cutoff 1305 ng/L)independently with the sensitivity and specificity 69.2%and 69.9%respectively(AUC=0.751,95%CI:0.672-0.819,P<0.05).There was no significant difference in D-Dimer concentrations between high-risk group,medium high-risk group,medium low-risk group and low-risk group(P>0.05).D-Dimer had no correlation with risk stratification(r=0.078,P>0.05)and poor performance in predicting RVD(AUC=0.569,95%CI:0.485-0.651,P>0.05).Concentrations of cTnI were higher in high-risk group,medium high-risk group,medium low-risk group than low-risk group(P<0.05)and positively correlated with risk stratification(r=0.303,P<0.05).The cutoff of cTnI in predicting RVD was 0.20μg/L,with the sensitivity and specificity 82.7%and 40.9%respectively(AUC=0.655,95%CI:0.571-0.732,P<0.05).Combination of NT-proBNP and cTnI was superior to single detection in predicting RVD(AUC=0.778,95%CI:0.701-0.842,P<0.05).Conclusion Levels of plasma NT-proBNP and cTnI elevate with the increase of risk stratification and are useful in the diagnosis of RVD,which may aid in risk stratification and prognosis in PE.D-Dimer levels are not associated with risk stratification and do not predict RVD well.