血浆D-二聚体N末端B型钠尿肽前体及超敏肌钙蛋白I在急性肺栓塞综合评估中的价值探讨

目的 应用肺栓塞严重程度指数（PESI）探讨D-二聚体、N末端B型钠尿肽前体（NT-proBNP）及超敏肌钙蛋白I （cTnI）在急性肺栓塞（APE）患者的病情严重程度及预后中的评估价值。方法 回顾性分析安徽省立医院2013年1月至2017年4月经肺动脉CT造影确诊的APE患者89例，根据简化版PESI评分将APE患者分为高危组（41例）与低危组（48例）。检测患者血浆D-二聚体、NT-proBNP及IcTnI水平，比较不同PESI评分及危险分层患者检验结果的差异，分析血浆D-二聚体、NT-proBNP以及cTnI水平在患者预后中的评估价值。结果 高危组患者的D-二聚体、NT-proBNP以及cTnI水平均高于低危组患者，差异有统计学意义（P<0.05），APE患者的D-二聚体、NT-proBNP以及cTnI水平与PESI评分（原始版）均呈正相关性（P<0.05）。在预后的多因素分析COX回归模型中，血浆D-二聚体、NT-proBNP及cTnI均为APE患者预后的独立危险因素，OR值依次为1.121、1.000、3.949。结论 APE患者血浆D-二聚体、NT-proBNP及cTnI可反映患者病情严重程度，联合检测对早期肺栓塞患者病情评估及预后作用明显。

Value of D-dimer, NTproBNP and cTnI in severity and prognosis assessmentof patients with acute pulmonary embolism

Objective To discuss the value of D-dimer, Nt-proBNP and troponin I (cTnI) in the severity and prognosis of APE patientsusing the severity index of pulmonary embolism (PESI).Methods Retrospective analysis wasperformed in89 cases of APE patients diagnosed by pulmonary artery CT angiography (CTPA) in Anhui Provincial Hospital from January 2013 to April 2017. According to the simplified PESI score, the patients were divided into the high-risk group (41 cases) and the low-risk group (48 cases). The levels of plasma D-dimer, NT-proBNP and cTnI were detected.The differences of the laboratory results in different PESI scores and risk stratificationwere compared, and the prognosis in patients with APE was evaluated.Results The levels of D-dimer, NT-proBNP and cTnI in high-risk group were significantly higher than those in low risk group, and the difference was statistically significant(P<0.05).The levels of D-dimer, NT-proBNP and cTnI of the patients with APE were positively correlated with the PESI score (P<0.05).In COX regression, D-dimer, NT-proBNP, and cTnI wereindependent risk factors for the prognosis of APE patients,and the OR values were 1.121, 1.000, and 3.949, respectively.Conclusion The D-dimer, NT-proBNP and cTnI in patients with APE can reflect the severity. The combined test has an obvious effect on the evaluation and prognosis of patients with early APE.