Abstract: Objective To explore the application value of B-type natriuretic peptide (BNP), D-dimer (DD), and homocysteine (Hcy) in the clinical diagnosis and risk classification of acute pulmonary embolism (APE). Methods A total of 89 APE patients admitted to the intensive care unit (ICU) of our hospital and 30 healthy physical examination people from July 2018 to June 2020 were selected as the research objects. According to the severity of APE, the patients were divided into high-risk group (36 cases), medium-risk group (31 cases), low-risk group (22 cases). The levels of BNP, DD, and Hcy in the three groups were detected and analyzed. Results Through one-way analysis of variance, the levels of BNP, DD, and Hcy in different risk grade APE patient groups and healthy control group were not exactly the same (all P<0.001), the BNP and Hcy levels of the high-risk group, medium-risk group, and low-risk group were higher than those of the healthy control group (all P<0.05), and the DD levels of the high-risk group and the medium-risk group were higher than those of the low-risk group and the healthy control group (all P<0.05). ROC curve analysis showed that the areas under the curves (AUC) of BNP, DD, and Hcy were 0.762, 0.583, and 0.644, respectively. When BNP, DD, and Hcy took 153.62 μg/L, 1.13 μg/L, and 15.24 μmol/L, they achieved the maximum diagnostic efficiency, with the sensitivity and specificity of 88.7% and 82.4% for BNP, 72.5% and 79.3% for DD, and 63.6% and 90.8% for Hcy. Spearman correlation analysis showed that the levels of BNP, DD, and Hcy were positively correlated with the risk classification of APE patients (r=0.736, 0.715, 0.628), with statistically significant differences (all P<0.05). Conclusion The levels of BNP, DD, and Hcy have important guiding significance in the clinical diagnosis and risk classification of APE. It is clinically recommended to perform these three tests at the same time for patients with suspected APE to obtain the best diagnostic accuracy.

Key words: Acute pulmonary embolism, B-type natriuretic peptide, D-dimer, Homocysteine

摘要： 目的 探讨B型钠尿肽(BNP)、D二聚体(DD)和同型半胱氨酸(Hcy)在急性肺栓塞(APE)临床诊断和危险分级中的应用价值。方法 选取2018年7月至2020年6月本院重症监护室(ICU)收治的89例APE患者和同时期体检健康者30例作为研究对象,APE患者根据患者急性肺栓塞病情严重程度分为高危险组(36例)、中危险组(31例)、低危险组(22例),检测并分析各组BNP、DD和Hcy的检测结果。结果 经单因素方差分析,不同危险等级APE患者组与健康对照组BNP、DD和Hcy水平不完全相同(均P<0.001),高危险组、中危险组和低危险组BNP和Hcy水平均高于健康对照组(均P<0.05),高危险组和中危险组DD水平高于低危险组和健康对照组(均P<0.05)。经ROC曲线分析,BNP、DD和Hcy的曲线下面积(AUC)分别为0.762、0.583和0.644,当BNP、DD和Hcy分别取153.62 μg/L、1.13 μg/L和15.24 μmol/L时具有最大诊断效能,BNP的敏感度和特异性分别为88.7%和82.4%,DD的敏感度和特异性分别为75.2%和79.3%,Hcy的敏感度和特异性分别为63.6%和90.8%。经Spearman相关性分析,BNP、DD和Hcy水平与APE患者危险分级呈正相关(r=0.736、0.715、0.628),差异均有统计学意义(均P<0.05)。结论 BNP、DD和Hcy水平检测在APE临床诊断和危险分级方面具有指导意义,临床上建议对于APE疑似患者同时进行该3项检测,以获取最佳的诊断准确性。

关键词: 急性肺栓塞, B型钠尿肽, D二聚体, 同型半胱氨酸