联合应用血浆肌钙蛋白Ⅰ、脑钠肽和超声心动图对急性肺栓塞的临床价值

目的探讨联合应用脑钠肽(BNP)、心肌肌钙蛋白Ⅰ(cTnI)和超声心动图检查在血压正常的急性肺栓塞(APE)患者中的临床意义。方法根据血浆cTnI和BNP水平将74例血流动力学稳定的APE患者分为三组:Group 1组(n=22),血浆cTnI水平≥0.1μg/L且BNP水平≥100 ng/L;Group 2组(n=20),血浆cTnI水平≥0.1μg/L或BNP水平≥100 ng/L;Group 3组(n=32),血浆cTnI水平<0.1μg/L且BNP水平<100 ng/L。分析cTnI和(或)BNP升高和超声心动图提示右心功能不全与APE患者危险分层及临床预后的关系。结果三组间呼吸困难、颈静脉充盈、P2亢进、心率、动脉血PaO2、P(A-a)O2及超声心动图提示右心功能不全比较差异均有统计学意义(P<0.05);三组临床不良事件分别为12例(54.5%)、4例(20%)、0例(0%),差异有统计学意义(P<0.001)。74例APE患者中右心功能不全患者的P(A-a)O2、cTnI、BNP高于右心功能正常者,差异均有统计学意义(P<0.05);PaO2则降低,差异有统计学意义(P=0.033)。结论联合应用血浆cTnI、BNP和超声心动图检查在血压正常的APE患者中有助于筛选出高危患者,指导临床决策。

Clinical Significance of Brain Natriuretic Peptide Combined with Cardiac Troponin I and Echocardiography in Acute Pulmonary Embolism

Objective To study the clinical significance of the combined use of serum cardiac troponin I(cTnI),brain natriuretic peptide(BNP)and in normotensive patients with acute pulmonary embolism(APE).Method A total of 74 patients with confirmed APE were divided into three groups according to serum cTnI and BNP levels,including Group 1(n=22),cTnI≥0.1 μg/L and BNP≥100 ng/L,Group 2(n=20)cTnI≥0.1 μg/L or BNP≥100 ng/L,and Group 3(n=32)cTnI<0.1 μg/L and BNP<100 ng/L.The clinical features and prognosis were analyzed and compared.Results There were significant differences in dyspnea,jugular engorgement,accentuated P2,tachycardia,arterial blood PaO2,P(A-a)O2(P<0.05).Patients with clinical adverse events in Group 1,2 and 3 numbered 12(54.5%),4(20%),and 0(0%),respectively,showing a significant difference(P<0.001).There were significant differences in arterial blood PaO2,P(A-a)O2,cTnI and BNP between the group of proceeding right ventricular dysfunction and the group of non-right ventricular dysfunction(P<0.05).Conclusion It is a good method to combine serum cTnI,BNP and echocardiography to screen high-risk patients among acute pulmonary embolism patients with normal blood pressure.