联合检测肌钙蛋白、氨基末端脑钠肽前体在急性肺栓塞中的临床意义

【作者】 杨帆；

【导师】 何涛；

【作者基本信息】 青岛大学 ， 内科学（心血管病）， 2018， 硕士

【摘要】 目的:探讨急性肺栓塞(APE)患者肌钙蛋白I(cTnI)和氨基末端脑钠肽前体(NT-proBNP)浓度变化以及在诊断、判断预后方面的意义。方法:收集临沂市中心医院2014年6月-2015年12月期间收治的急性肺栓塞患者42例为实验组,所有患者均行肺动脉CT血管成像检查(肺动脉CTA)确诊肺栓塞,所有患者入院后48小时内行彩色多普勒超声心动图检查。记录患者住院期间发生的严重不良事件,包括休克、气管插管、机械通气、心肺复苏、死亡,根据有无严重不良事件发生分为预后不良组(9例)和预后良好组(33例)。同一时期随机选取我院40名健康体检者为对照组。分别进行cTnI、NT-pro BNP浓度检测。对实验组的一般资料、危险因素进行分析,对实验组与对照组,预后良好组与预后不良组的cTnI、NT-proBNP数据进行对比分析。结果:1、实验组42例患者中,最常见的症状为呼吸困难(61.9%)、胸痛(30.9%)、晕厥(19.0%)、休克(11.9%)、咯血(9.5%),最常见的体征为心动过速(心率>100次/分)(47.6%)。2、大部分患者存在一项或多项已知的危险因素,其中较为常见的有下肢或骨盆骨折、严重外伤、长期大量吸烟史、合并下肢静脉曲张、合并深静脉血栓形成等。3、实验组cTnI为(1.2±0.56)ng/mL,NT-proBNP为(1223±445)pg/mL,对照组cTnI为(0.1±0.13)ng/m L,NT-proBNP为(40±17.4)pg/mL,实验组cTnI、NT-proBNP浓度明显高于对照组,两组比较差异有统计学意义(P<0.05)。4、肺栓塞病人中预后不良组cTnI为(3.3±1.56)ng/ml,NT-pro BNP为(4483±960)pg/mL,预后良好组cTnI为(0.7±0.37)ng/ml,NT-proBNP为(562±118)pg/mL,实验组中预后不良组cTn I、NT-proBNP浓度较预后良好组高,两组比较差异有统计学意义(P<0.05)。结论:1、急性肺栓塞在临床上越来越多见,其病情重,死亡率较高,误诊、漏诊率较高,在临床工作中,对于可疑肺栓塞患者,应联合应用D-二聚体、超声心动图、螺旋CT等检查手段,提高诊断率,尽早给予针对性治疗,以挽救患者生命。2、血浆氨基末端脑钠肽前体(NT-proBNP)及肌钙蛋白(cTn)浓度水平对急性肺栓塞的诊断和排除诊断具有较好的临床意义,还可作为肺栓塞患者病情严重程度及预后判断的指标,值得推广。更多还原

【Abstract】 Objective:To explore the concentration change,the diagnostic and prognostic clinical meaning of cardiac troponin I(cTnI)and amino-terminal brain natriuretic peptide precursor(NT-proBNP)in acute pulmonary embolism(APE)patients.Methods:42 APE patients from June 2014 to December 2015 of Central Hospital of Lin Yi were selected as experimental group,all patients were diagnosed by computer tomography pulmonary angiography(CTPA).All patients did color Doppler echocardiography in 48 hours after admission.The basic information,symptoms,signs and risk factors of the 42 patients were recorded.Severe adverse events were recorded during hospitalization,including shock,endotracheal intubation,mechanical ventilation,cardiopulmonary resuscitation,and death,According to the clinical outcome,APE patients were divided into good outcome group and bad outcome group,and 40 healthy people for physical examination in our hospital at the same period were selected as control group.The distribution of basic data,symptoms,signs and risk factors in the experimental group were analyzed.The concentration of cTnI and NT-proBNP in experimental group and control group,in good outcome group and bad outcome group,was compared respectively.Results:Among the 42 patients in the experimental group,the most common symptoms were dyspnea(61.9 %),chest pain(30.9 %),syncope(19 %),shock(11.9 %),and hemoptysis(9.5%),and the most common sign was tachycardia(heart rate >100 / score)(47.6 %).Most of the patients have one or more known risk factors,such as lower limbs or pelvic fractures,severe trauma,a long history of smoking,combined varicose veins of lower extremity,and deep venous thrombosis.APE group:cTnI of is(1.2±0.56)ng/mL,NT-proBNP is(1223±445)pg/mL,control group:cTnI is(0.1±0.13)ng/mL,NT-proBNP is(40±17.4)pg/mL,the difference was statistically significant(P<0.05).In the APE patients,bad outcome group: cTnI is(3.3±1.56)ng/ml,NT-proBNP is(4483±960)pg/mL,good outcome group : cTnI is(0.7±0.37)ng/ml,NT-proBNP is(562±118)pg/m L,the difference was statistically significant(P<0.05).The concentration of cTnI and NT-proBNP in experimental group was significantly higher than that of control group,and the concentration of cInI and NT-proBNP in bad outcome group was higher than that of good outcome group,the difference was statistically significant(P<0.05).Conclusion:1.More and more acute pulmonary embolism is seen in clinic.Its condition is heavy,the mortality rate is high,misdiagnosis and missed diagnosis rate is high.In clinical work,for suspected pulmonary embolism patients,D-two polymer,echocardiography,spiral CT should be combined to improve the diagnosis rate and give the targeted treatment as early as possible in order to save the patient’s life.Life.2.The level of plasma amino terminal natriuretic peptide precursor(NT-proBNP)and troponin(cTn)is of good clinical significance for the diagnosis and diagnosis of acute pulmonary embolism.It can also be used as an indicator of the severity and prognosis of pulmonary embolism.更多还原