急性肺栓塞患者危险分层的生物学指标.docVIP

-------临床心血管病杂志 急性肺栓塞患者危险分层的生物学指标 王淑红　韩勤甫　申娟　金培印　张海柱　刘建敏　贾银明 河南安阳市人民医院心内科　　455000 摘要：目的　通过检测急性肺栓塞(APE)患者血浆中肌钙蛋白cTnT)、N端B型尿钠肽前体（NT-proBNP）及C-反应蛋白（CRP）的浓度，探讨联合检测生物学指标cTnT、 NT-proBNP和CRP对APE患者进行危险分层及预后判断的临床意义。方法 65例患者行超声心动图检查右心室功能将APE患者分为右心室功能不全组、无右心室功能不全两组。同时检测血浆cTnT、NT-proBNP和CRP水平,分析联合检测cTnT、NT-proBNP和CRP对APE患者危险分层与临床预后的关系。结果　65例患者中发生右心室功能不全37（56.9%）例，无右心室功能不全28（43.1%）例。两组间动脉血PaO2、P(A-a)O2、血浆NT-proBNP 、cTnT和CRP水平比较差异有统计学意义(P0.01)。两组预后不良者分别为16例(43.2%)、3例(10.7%)差异有统计学意义(P0.01)。65例APE患者中临床不良事件发生组与无临床不良事件组比较cTnT、NT-proBNP、CRP及PaO2水平差异均有统计学意义(P0.01)。相关分析显示NT-proBNP与cTnT、CRP及PaO2均呈正相关（r分别为0.46, 0.39，0.56，0.39，均P0.05）。结论　联合检测生物学指标cTnT 、NT-proBNP和CRP在APE患者早期危险分层、指导临床决策及预后判断中具有重要价值。 关键词： N端B型尿钠肽前体，肌钙蛋白Biological markers for risk stratification of acute pulmonary embolism Wang shuhong，Han qinfu，Shen juan，et al (Department of Cardiology, Anyang People, s Hospital, 455000) Abstract: Objective To investigate the clinical value of detecting cardiac troponin T (cTnT) , N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) for risk stratification and prognosis evaluation in patients with acute pulmonary embolism(APE).Methods 59 patients with confirmed APE were divided into three groups according to degree of serum cTnT and NT-proBNP: Group1 (n=14): cTnT0.1ng/ml and NT-proBNP 100pg/ml; Group 2 (n=28): cTnT≥0.1ng/ml or NT-proBNP≥100pg/ml; Group3 (n=17): cTnT≥0.1ng/ml and NT-proBNP≥100pg/ml.The relations between cTnT and NT-proBNP and risk stratification and prognosis evalCRPtion were evalCRPted in the three groups. Results Patients with prognosis mala in group1,group2 and group3 were0 cases (0%)、7 cases (25%),9 cases (52.9%)respectively and a significant difference was observed(P0.01). There were significant differences in arterial blood PaO2, cTnT and NT-proBNP in the group of proceeding clinical harmful events (p0.01). Conclusions Combinational detection of cTnT and NT-proBNP has important value for early risk stratification and prognosis evalCRP