摘要
目的 :探讨肌钙蛋白T(cardial troponin T,c-Tn-T)和脑利钠肽(brain natriuretic peptide,BNP)评价急性肺栓塞(acutepulmonary embolism,APE)患者病情严重程度,及其预测预后的价值。方法 :选取南京医科大学第一附属医院急诊科2005年1月～2009年7月确诊的APE患者251例,收集其c-Tn-T、BNP、血气分析(PaO2和PaCO2)检测结果、心脏多普勒指标和临床转归情况;根据血气结果将APE患者分为轻、中、重3组,比较组间差异及其相关性;根据临床转归,分为预后良好组和预后不良组,比较两组间c-Tn-T、BNP、PaO2和PaCO2差异,评价c-TnT、BNP对APE患者预后的预测价值。结果:随着APE严重程度增加,c-Tn-T、BNP指标显著升高和右心功能不全发生率显著增加,差异有统计学意义(P<0.05)。右心室扩大与c-Tn-T和BNP呈正相关(r=0.614,P=0.001;r=0.598,P=0.005),收缩期室间隔反向运动与BNP呈正相关(r=0.791,P=0.000),肺动脉高压与c-Tn-T呈正相关(r=0.711,P=0.000)。预后不良组c-Tn-T、BNP、PaO2和PaCO2和右心功能不全明显差于预后良好组(P<0.05)。ROC曲线分析显示,cTn-T和BNP的曲线下面积(area under curve,AUC)均较大,其最佳工作点分别为0.94 ng/ml和458.12pg/ml。结论:c-Tn-T和BNP能很好评估APE患者疾病严重性,同时也能很好的预测APE患者临床转归,为临床治疗和预后评估提供客观依据。
Objective： To evaluate the severity of acute pulmonary embolism（APE） patients by cardial troponin T（c-Tn-T） and brain natriuretic peptide（BNP） and explore its prognostic value.Methods： From January 2005 to July 2009,251 patients diagnosed with APE were enrolled in this study.The level of c-Tn-T and BNP,PaO2 and PaCO2,heart doppler index and clinical outcomes situation were collected.According to the results of PaO2 and PaCO2,patients of APE were divided into three groups.We compared differences between groups and analyzed the correlation.According to the clinical outcome,patients of APE were divided into good outcome group and bad outcome group.We compared the differences between two groups of c-Tn-T,BNP,PaO2,PaCO2 and the predictive values from c-Tn-T and BNP.Results： Along with serious degree of APE increased,c-Tn-T and BNP index significantly increased,and the right cardiac insufficiency significantly increased with statistically significant difference（P 0.05）.Right ventricular enlargement was positively correlated with c-Tn-T and BNP（r = 0.614,P = 0.001;r = 0.598,P = 0.005）;Systolic ventricular septal retrorse motion positively correlated with BNP（r = 0.791,P = 0.000）;Pulmonary hypertension positively correlated with c-Tn-T（r = 0.711,P = 0.000）.To the group with bad outcome,the c-Tn-T,BNP,PaO2,PaCO2 and right cardiac insufficiency were obviously poorer than the group with good outcome（P 0.05）.ROC curves analysis showed that the area under curve（AUC） were large in the curve of the BNP and c-Tn-T.The optimum operating point for c-Tn-T and BNP were 0.94 ng/ml and 458.12 pg/ml,respectively.Conclusion： c-Tn-T and BNP can assess severity of disease for APE patients.At the same time,they also provide an objective basis for clinical treatment and prognosis assessment.
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2012年第1期82-85,共4页
Journal of Nanjing Medical University(Natural Sciences)
关键词
肺栓塞
肌钙蛋白T
脑利钠肽
预后
评价
pulmonary embolism
cardial troponin T
brain natriuretic peptide
prognostic
prediction
