N末端B型利钠肽原与急性肺血栓栓塞症后血栓复发的相关性分析  

Correlation analysis between N-terminal pro-brain natriuretic peptide and thrombosis recurrence after acute pulmonary embolism

作　　者：王勇[1] 赵亚丹 张洪亮[1] 罗勤[1] 赵智慧[1] 赵青[1] 柳志红[1] 熊长明 倪新海[1] Wang Yong;Zhao Yadan;Zhang Hongliang;Luo Qin;Zhao Zhihui;Zhao Qing;Liu Zhihong;Xiong Changming;Ni Xinhai(Center for Pulmonary Vascular Disease Diagnosis and Treatment, State Key Laboratory of Cardiovascular Disease,Fuwai Hospital, National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037, China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心,阜外医院心血管疾病国家重点实验室,肺血管病诊治中心,100037

出　　处：《中国心血管杂志》2020年第2期116-120,共5页Chinese Journal of Cardiovascular Medicine

基　　金：国家重点研发计划项目(2016-ZDYF05)。

摘　　要：目的评价血浆N末端B型利钠肽原(NT-proBNP)水平在急性肺血栓栓塞症(PE)中远期血栓复发事件中的预测价值。方法前瞻性连续入选自2005年1月至2010年10月间首次发作的急性PE患者共224例,入院后取血检测其血浆NT-proBNP水平,并根据NT-proBNP水平分为NT-proBNP升高组和NT-proBNP正常组。分别在3、6和12个月以及其后每年一次进行系统性评估随访。主要研究终点是症状性复发致死或非致死性静脉血栓栓塞事件(VTE)。结果在224例入选患者中,158例(70.5%)患者的血浆NT-proBNP升高,而66例(29.5%)患者检测结果正常。平均随访(31.0±19.4)个月后,在血浆NT-proBNP水平升高组中共20例(12.6%)患者发生VTE复发事件,血浆NT-proBNP水平正常组中仅1例(1.5%)患者发生VTE复发事件。NT-proBNP升高组的VTE复发事件发生率明显高于NT-proBNP正常组(12.6%比1.5%,P=0.009)。在Cox多因素分析中,调整口服抗凝药物治疗时间后,血浆NT-proBNP水平升高是急性PE患者VTE复发的独立预测因子(HR=10.50,95%CI:1.42~78.23,P=0.02)。结论血浆NT-proBNP水平升高是急性PE患者VTE事件复发的独立预测因子。Objective To assess the predictive value of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)with regard to recurrent venous thromboembolism(VTE)in acute pulmonary thromboembolism(PE).Methods NT-proBNP levels were measured in 224 consecutive patients with the first episode of acute pulmonary embolism occurring from January 2005 to October 2010.According to NT-proBNP levels,they were divided in elevated NT-proBNP group and normal NT-proBNP group.Follow-ups were performed at 3,6,and 12 months and annualy thereafter.The primary end point was symptomatic,recurrent fatal or nonfatal VTE.Results Among 224 selected patients,NT-proBNP was elevated in 158(70.5%)patients and not elevated in 66(29.5%)patients.After a mean follow-up period of 31.0±19.4 months,patients with elevated NT-proBNP showed an increased risk of recurrent VTE(20 patients,12.6%)compared to those with normal NT-proBNP(only 1 patient,1.5%,P=0.009).In a multivariate analysis stratified by oral anticoagulant treatment duration,elevated NT-proBNP was an independent predictor of recurrent VTE(HR:10.50,95%CI:1.42-78.23,P=0.02).Conclusions Elevated NT-proBNP is associated with recurrent VTE in acute pulmonary embolism patients.

关 键 词：肺栓塞 N末端B型利钠肽原 静脉血栓栓塞 复发 

分 类 号：R54[医药卫生—心血管疾病]