| Objective:To investigate the predictive value of brain natriuretic peptide(BNP)and oxygenation index(OI)on myocardial injury in patients with acute pulmonary thromboembolism(APTE).Methods :According to the inclusion criteria and exclusion criteria,the baseline data,BNP,arterial blood gas analysis,cardiac troponin I(c Tn I)and echocardiography of patients diagnosed with APTE in the Affiliated Hospital of Chengde Medical College from January 2019 to March 2022 were collected.The patients were divided into myocardial injury group and non-myocardial injury group according to the results of c Tn I(c Tn I>0.4ng /ml was myocardial injury,c Tn I≤0.4ng/ml was non-myocardial injury).The baseline data,pulmonary artery systolic pressure(PASP),right ventricular function,BNP and OI were compared between the two groups.Univariate and multivariate binary logistic regression analysis were used to analyze the factors affecting myocardial injury in APTE patients.The predictive value of BNP and OI levels for myocardial injury in APTE was compared,and the predictive probability of logistic regression obtained by combining the above two indicators was analyzed.ROC curve was drawn to evaluate its predictive value.All results were statistically significant at P<0.05.Results :1.There was no significant difference in baseline data(demographics,clinical manifestations)between the two groups(all P>0.05).2.Comparison of PASP levels between the two groups,the myocardial injury group was significantly higher than the non-myocardial injury group(55mm Hg vs 42 mm Hg),the difference was statistically significant(P<0.05).3.Comparison of the incidence of right ventricular dysfunction(RVD)between the two groups of patients,RVD patients in the myocardial injury group were significantly more than those in the non-myocardial injury group(31 vs 13),and the difference was statistically significant(P<0.05).4.Comparison of BNP levels between the two groups of patients,the myocardial injury group was significantly higher than the non-myocardial injury group(226.84pg/ml vs 74.00pg/ml),the difference was statistically significant(P<0.05).5.Comparison of OI between the two groups of patients,the myocardial injury group was significantly lower than the non-myocardial injury group(234.67±46.07 mm Hg vs 302.69±88.25 mm Hg),the difference was statistically significant(P<0.05).6.Binary Logistic regression analysis of risk factorsUnivariate binary logistic regression analysis of PASP,RVD,BNP and OI showed that PASP,RVD and BNP were risk factors for myocardial injury in APTE patients,and OI was a protective factor for myocardial injury in APTE patients(P<0.05).Multivariate binary Logistic regression analysis of PASP,RVD,BNP and OI showed that BNP was an independent risk factor for myocardial injury in APTE patients,and OI was an independent protective factor for myocardial injury in APTE patients(P<0.05).7.ROC curve of BNP,OI and their combination in predicting myocardial injury in APTE patientsThe area under the curve(AUC)of BNP and OI in predicting myocardial injury in APTE patients was 0.721(95 % CI : 0.643-0.800)and0.753(95 % CI : 0.681-0.824),respectively.The optimal cut-off values were199.00 and 289.33,respectively.The sensitivity was 58.7 % and 58.4 %,the specificity was 81.2 % and 88.0 %,the positive predictive value was 69.8%and 61.1 %,and the negative predictive value was 72.6% and 86.8%,respectively.The AUC of the combined prediction of myocardial injury in APTE patients was 0.797(95 % CI : 0.733-0.860),the best cutoff value was0.292,the sensitivity was 92.0%,and the specificity was 56.4%.The positive predictive value was 61.1% and the negative predictive value was 90.5%.Conclusion :1.PASP and RVD has a certain predictive value for myocardial injury in APTE patients.2.BNP is an independent risk factor for myocardial injury in APTE patients,so it has a certain predictive value for myocardial injury in APTE patients.3.OI is an independent protective factor for myocardial injury in APTE patients,so it has certain predictive value for myocardial injury in APTE patients.4.The combined detection of BNP and OI is superior to individual detection,and has a synergistic effect,which can further improve the predictive value of APTE patients with myocardial injury. |
PDF Full Text Request