Ohigashi Hirokazu, Haraguchi Go, Yoshikawa Shunji, Sasaki Takeshi, Kimura Shigeki, Inagaki Hiroshi, Hachiya Hitoshi, Hirao Kenzo, Isobe Mitsuaki
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
Int Heart J. 2010;51(6):416-20. doi: 10.1536/ihj.51.416.
Biomarkers are needed for early risk stratification and improved inpatient management to obtain better outcomes in acute pulmonary embolism (PE) patients. The aim of the present study was to evaluate biomarkers of right ventricular dysfunction (RVD) in order to predict a complicated clinical course and long-term respiratory complications in acute PE.We retrospectively enrolled 50 consecutive patients hospitalized for acute PE. Plasma brain natriuretic peptide (BNP), troponin-I, fibrin degradation products, D-dimer, C-reactive protein, and arterial pH were measured to assess their prognostic significance. RVD was evaluated by echocardiography at admission, the clinical course during hospitalization was monitored for the development of complications (death, cardiopulmonary resuscitation, mechanical ventilation or circulatory shock), and the need for home oxygen therapy (HOT) was assessed at/after discharge.Thirty-two patients (64%) had RVD at admission, 6 (12%) developed a complicated clinical course, and 7 (14%) required HOT. Plasma BNP was significantly higher in patients with RVD (median value, 319.3 versus 50.5 pg/mL, P = 0.001). Plasma BNP was also significantly higher (median value, 1307.9 versus 102.6 pg/mL, P = 0.02) and arterial pH significantly lower (acidic) (median value, 7.371 versus 7.438, P = 0.008) in patients who developed a complicated clinical course. In addition, plasma BNP was also significantly higher in patients who required HOT (median value, 505.1 versus 91.1 pg/mL, P = 0.02). Plasma BNP at admission is not only a reliable marker of RVD and predictor of short-term prognosis, but also a predictor of long-term respiratory prognosis in acute PE patients.
急性肺栓塞（PE）患者需要生物标志物来进行早期风险分层并改善住院管理，以获得更好的治疗结果。本研究的目的是评估右心室功能不全（RVD）的生物标志物，以预测急性PE患者复杂的临床病程和长期呼吸并发症。我们回顾性纳入了50例因急性PE住院的连续患者。检测血浆脑钠肽（BNP）、肌钙蛋白I、纤维蛋白降解产物、D-二聚体、C反应蛋白和动脉血pH值，以评估其预后意义。入院时通过超声心动图评估RVD，监测住院期间的临床病程以观察并发症（死亡、心肺复苏、机械通气或循环休克）的发生情况，并在出院时/出院后评估家庭氧疗（HOT）的需求。32例患者（64%）入院时存在RVD，6例（12%）出现复杂的临床病程，7例（14%）需要HOT。RVD患者的血浆BNP显著更高（中位数，319.3对50.5 pg/mL，P = 0.001）。出现复杂临床病程的患者血浆BNP也显著更高（中位数，1307.9对102.6 pg/mL，P = 0.02），动脉血pH值显著更低（呈酸性）（中位数，7.371对7.438, P = 0.008）。此外，需要HOT的患者血浆BNP也显著更高（中位数，505.1对91.1 pg/mL，P = 0.02）。入院时的血浆BNP不仅是RVD的可靠标志物和短期预后的预测指标，也是急性PE患者长期呼吸预后的预测指标。
