| Objective: To investigate the changes of plasma troponin Ⅰ and brain natriuretic peptide levels in patients with acute pulmonary embolism and to analyze the prognostic risk factors in patients with acute pulmonary embolism.Methods: A total of 108 patients with acute pulmonary embolism who were admitted to our hospital from March 2013 to March 2017 were randomized.All patients were given diagnosis and treatment within 48 hours after admission and they were diagnosed according to 2010 Chinese experts’ consensus on diagnosis of acute pulmonary embolism.The patients were grouped according to risk stratification criteria.Among them,21 patients were in high-risk pulmonary embolism group and 87 patients in non-high-risk pulmonary embolism group.According to diagnostic criteria for echocardiography(RV/LV>0.9,decreased TAPSE,decreased right ventricular free wall motion),right heart dysfunction was assessed,and a multi-functional microplate reader and chemically-immunized human brain natriuretic peptide test were used to detect acute pulmonary embolism.Changes in plasma troponin Ⅰ and brain natriuretic peptide levels were compared between plasma troponin Ⅰ levels and brain natriuretic peptide levels in the two groups,as well as the correlation between the two indices.Efficacy and plasma troponin Ⅰ levels were evaluated.The relationship between brain natriuretic peptide level and prognostic risk factors were analyzed in both groups.Results:1.There was no significant difference in the age and sex between the non-high-risk pulmonary embolism group and the high-risk pulmonary embolism group(P>0.05).2.The brain natriuretic peptide(602.09±78.05)pg/ml in high-risk pulmo-nary embolism group was significantly higher than that in non-high-risk pulmonary embolism group(451.49±58.34)pg/ml,and statistical analysis showed significant differences(P<0.05);The levels of cardiac troponin I(2.13±0.45)ng/ml were significantly higher in the high-risk pulmonary embolism group than in the non-high-risk pulmonary embolism group(1.35±0.16)ng/ml,and the statistical analysis showed significant differences(P<0.05).3.The effective rate of high-risk pulmonary embolism group was 38.10%,the improvement rate was 33.33%,inefficiency was 28.57%,and the total effective rate was 71.43%.The effective rate of non-high-risk pulmonary embolism group was 40.23%,the improvement rate was 32.18%,the inefficiency rate was 27.59%,and the total effective rate was 72.41%.there was no significant difference the total effective rate.4.According to the different effects,high-risk pulmonary embolism group was divided into marked effect group,improvement group and invalid group.The brain natriuretic peptide in the marked effect group(534.93±15.36)pg/ml was significantly lower than the improvement group(585.39±21.26)pg/ml,and statistical analysis showed significant differences(P<0.05).The brain natriuretic peptide in the marked effect group(534.93±15.36)pg/ml was significantly lower than the invalid group(650.36±32.24)pg/ml,and statistical analysis showed significant differences(P<0.05).The brain natriuretic peptide in the improvement group(585.39±21.26)pg/ml was significantly lower than the invalid group(650.36±32.24)pg/ml,and statistical analysis showed significant differences(P<0.05).The plasma troponin Ⅰ in the marked effect group(1.64±0.10)ng/ml was significantly lower than in the improvement group(1.98±0.15)ng/ml.The plasma troponin Ⅰ in the marked effect group(1.64±0.10)ng/ml was significantly lower than in the invalid group(2.45±0.18)ng/ml.The plasma troponin I in the improvement group(1.98±0.15)ng/ml was significantly lower than in the invalid group(2.45±0.18)ng/ml,and all data were statistically significant(P<0.05).5.According to the different effects,non-high-risk pulmonary embolism group was divided into marked effect group,improvement group and invalid group.there was no significant difference in brain natriuretic peptide in the marked effect group(423.69±28.25)pg/ml and improvement group(438.38±25.46)pg/ml(P>0.05);The brain natriuretic peptide in the marked effect group(423.69±28.25)pg/ml was significantly lower than the invalid group(486.69±22.84)pg/ml,and statistical analysis showed significant differences(P<0.05).The brain natriuretic peptide in the improvement group(438.38±25.46)pg/ml was significantly lower than the invalid group(486.69±22.84)pg/ml,and statistical analysis showed significant differences(P<0.05).There was no significant difference in plasma troponin I in the marked effect group(1.15±0.06)ng/ml and the improvement group(1.18±0.07)ng/ml(P>0.05).The plasma troponin I in the marked effect group(1.15±0.06)ng/ml was significantly lower than in the invalid group(1.45±0.12)ng/ml.The plasma troponin Ⅰ in the improvement group(1.18±0.07)ng/ml was significantly lower than in the invalid group(1.45±0.12)ng/ml,and all data were statistically significant(P<0.05).6.The correlation analysis between the plasma troponin Ⅰ and plasma brain natriuretic peptide concentration showed that there was a significant positive correlation between the two,and the pearson correlation coefficient was 0.762,P<0.05,showing a linear correlation.F=77.9,P<0.001,regression equation: Y=0.762X±371.6.7.For patients with high-risk pulmonary embolism,the risk factors for their prognosis are age≥65 years old,deep venous thrombosis,chronic heart and lung disease,deep venous thrombosis,long-term bedridden,malignant tumor,surgery,recent surgery,diabetes,hyperlipidemia,plasma troponin and brain natriuretic peptide levels increased.In the non-high risk pulmonary embolism group,the risk factors for prognosis were age ≥65 years,deep venous thrombosis,chronic heart and lung disease,deep venous thrombosis,long-term bedridden,malignant tumor,surgery,recent surgery,diabetes,hyperlipidemia,elevated plasma troponin levels,elevated brain natriuretic peptide levels,and right ventricular dysfunction.Conclusion:1.Plasma brain natriuretic peptide and cardiac troponin Ⅰ levels are closely related to high risk and non-high risk stratification of acute pulmonary embolism.2.Plasma brain natriuretic peptide and cardiac troponin Ⅰ levels are closely related to the efficacy of acute pulmonary embolism.The lower the concentration of brain natriuretic peptide and troponin I,the better the effect is.3.Age≥65 years old,deep venous thrombosis,chronic heart and lung disease,deep venous thrombosis,long-term bedridden,malignant tumor,surgery,recent surgery,diabetes,hyperlipidemia,plasma troponin,brain natriuretic peptide,right heart dysfunction is a poor prognostic risk factor for acute pulmonary embolism. |
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