肺栓塞危险因素和联合检测cTnT、BNP、CRP、D-二聚体的临床分析

目的探讨肺栓塞危险因素及检测心肌肌钙蛋白T(cTnT)、脑钠肽(BNP)、C反应蛋白(CRP)、D-二聚体对其诊断及危险分层的意义。方法收集2014年8月至2016年7月第四年医大学唐都医院呼吸科住院的通过临床表现、辅助检查等确诊为急性肺栓塞患者103例,分为高危组、中危组、低危组,并对危险因素及异常指标进行回顾性分析。结果深静脉血栓形成是最重要的危险因素(46.6%),其次年龄65岁(39.8%)、心血管疾病(26.2%)、肿瘤(22.3%)、外科手术(18.4%)、慢性肺部疾病(17.5%)、创伤与骨折(13.6%),再次是下肢静脉曲张或静脉炎(9.7%);检查异常指标中,三组D-二聚体升高的患者占96.117%,三组间无统计学差异(P=0.217),高危组、中危组中cTnT、BNP、CRP升高的例数均较低危组多,高危组也多于中危组,各组间相比有统计学差异(P0.05)。结论深静脉血栓是肺栓塞最重要的危险因素,D-二聚体在肺栓塞中升高的敏感性最高,但也存在D-二聚体阴性的肺栓塞,D-二聚体、cTnT、BNP、CRP与其危险分层呈正相关。

Clinical analysis of risk factors for pulmonary embolism and joint detection of cTnT,BNP, CRP,D-dimer

Objective To review the risk factors of pulmonary embolism and explore the combined detection of cardiac troponin T(cTnT),brain natriuretic peptide (BNP),C-reactive protein (CRP),D-dimer for diagnosis and risk stratification of the guiding significance.Methods All 103 patients with acute pulmonary embolism were collected by clinical manifestation and auxiliary examination confirmed from August 2014 to July 2016 in department of respiratory of Tangdu Hospital of Fourth Military Medical Unirersity and divided into high-risk group,the moderate-risk group,the low risk group,retrospectively analyzed the risk factors and abnormal index.Results The incidence of deep venous thrombosis was the most important risk factor in 46.6％,followed by age＞65 years old 39.8％,cardiovascular disease 26.2％,tumor 22.3％,surgery 18.4％,chronic lung disease 17.5％,trauma and fracture 13.6％.Again,lower limb varicose veins or phlebitis 9.7％.The abnormal checking indicators:The patients of D-dimer increased accounted for 96.117％ in three groups.There were no statistical difference between them(P=0.217).The number of elevated cTnT,BNP and CRP in high-risk group and moderate-risk group were higher than that in low-risk group,the high-risk group was also higher than moderate group,each group compared to statistically significant (P＜ 0.05).Conclusions Deep vein thrombosis was the most important risk factors of pulmonary embolism.The sensitive of elevated D-dimer was the most in pulmonary embolism.There was D-dimer-negative pulmonary embolism and cTnT,BNP and CRP were positively correlated with risk stratification.