Alonso-Martínez José Luis, Urbieta-Echezarreta Miren, Anniccherico-Sánchez Francisco Javier, Abínzano-Guillén Maria Luisa, Garcia-Sanchotena Jose Luis
Department of Internal Medicine, Hospital de Navarra, Pamplona, Spain.
Am J Med Sci. 2009 Feb;337(2):88-92. doi: 10.1097/MAJ.0b013e318182d33e.
In acute pulmonary embolism (PE), brain natriuretic peptides are markers of right ventricular dysfunction and they could point out the size of the occluded pulmonary vessel.
N-terminal pro-B-type natriuretic peptide (BNP) was measured in 93 consecutive outpatients diagnosed with acute PE by means of helical computed tomography. Central PE was diagnosed when thrombotic material was seen in the main trunk or right or left main branches of the pulmonary artery, and peripheral PE was diagnosed when thrombi were seen exclusively in segmental or subsegmental arteries.
Central PE occurred in 51 (55%) patients and peripheral PE in 42 (45%). Plasma level of pro-BNP greater than 500 ng/L was independently associated with central PE. The area under the receiver operating characteristic curve was 0.753 (CI 95% 0.700-0.806), sensitivity 0.82 (CI 95% 0.69-0.91), specificity 0.67 (CI 95% 0.50-0.79), positive predictive value 0.75 (CI 95% 0.61-0.85), and negative predictive value 0.76 (CI 95% 0.58-0.87). Six (6%) patients died, 3 from PE, 2 from brain hemorrhage, and 1 from advanced gallbladder cancer. N-terminal pro-BNP level was greater than 500 ng/L in all patients who died. The area under receiver operating characteristic curve for death was 0.712 (CI 95% 0.635-0.789), sensitivity 0.10 (CI 95% 0.04-0.22), specificity 1 (CI 95% 0.88-1), positive predictive value 1 (CI 95% 0.51-1), and negative predictive value 0.42 (CI 95% 0.32-0.53).
Preliminary data suggest that N-terminal pro-BNP levels higher than 500 ng/L could serve as indicator of the burden of PE and perhaps as a predictor of death.
在急性肺栓塞（PE）中，脑钠肽是右心室功能障碍的标志物，它们可以指出被阻塞的肺血管的大小。
对93例通过螺旋计算机断层扫描诊断为急性PE的连续门诊患者测量N末端B型脑钠肽原（BNP）。当在肺动脉主干或右或左主分支中见到血栓物质时诊断为中央型PE，当仅在节段性或亚节段性动脉中见到血栓时诊断为周围型PE。
51例（55%）患者发生中央型PE，42例（45%）患者发生周围型PE。血浆B型脑钠肽原水平大于500 ng/L与中央型PE独立相关。受试者工作特征曲线下面积为0.753（95%CI 0.700 - 0.806），敏感性0.82（95%CI 0.69 - 0.91），特异性0.67（95%CI 0.50 - 0.79），阳性预测值0.75（95%CI 0.61 - 0.85），阴性预测值0.76（95%CI 0.58 - 0.87）。6例（6%）患者死亡，3例死于PE，2例死于脑出血，1例死于晚期胆囊癌。所有死亡患者的N末端B型脑钠肽原水平均大于500 ng/L。死亡的受试者工作特征曲线下面积为0.712（95%CI 0.635 - 0.789），敏感性0.10（95%CI 0.04 - 0.22），特异性1（95%CI 0.88 - 1），阳性预测值1（95%CI 0.51 - 1），阴性预测值0.42（95%CI 0.32 - 0053）。
初步数据表明，N末端B型脑钠肽原水平高于500 ng/L可作为PE严重程度的指标，也可能作为死亡的预测指标。
