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急性肺栓塞における脳ナトリウレチンペプチドの予後的役割
Nils Kucher1, Gert Printzen, Samuel Z Goldhaber
1Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Harvard Medical School, Boston, Mass 02115, USA.
Circulation
|May 14, 2003
まとめ
プラズマ脳ナトリウレチンペプチド (BNP) は,急性肺栓塞 (PE) の結果を予測するのに役立ちます. 低BNP値<50pg/mLは,良性臨床経過を有する患者をより良く識別しますが,低レベルは,合併症のない結果を保証しません.
科学分野:
- 心臓病学 心臓病学
- バイオマーカー バイオマーカー
- 肺内医学 肺内医学 肺内医学
背景:
- 急性肺栓塞 (PE) は,迅速な予後評価を必要とする.
- 非侵襲的予後のための安価な心臓バイオマーカーが必要である.
- プラズマ脳ナトリウレチンペプチド (BNP) は,PEの予後のための潜在的なバイオマーカーです.
研究 の 目的:
- 急性PEの臨床経過を予測する際の血BNP濃度の有用性を評価する.
- 急性PE患者の予後のために最適なBNPカットオフレベルを決定する.
主な方法:
- 血のBNP濃度は,73人の連続した急性PE患者の入院時に測定されました.
- 既定のBNPカットオフ値<90pg/mLは,主要な心血管疾患の有害事象の欠如を予測するために使用されました.
- 受信機の動作特性分析により,最適なBNPカットオフレベルが特定されました.
主要な成果:
- 副作用 (194.2 pg/mL) と良性経過 (39.1 pg/mL;P<0.001) の患者では,平均BNPがより高かった.
- 90pg/mL未満のBNPカットオフ値は,有害なアウトカムの93%の否定的な予測値でした.
- 副作用が出た3人の患者は,入院時のBNP濃度が低かった (<90pg/mL).
- ROC分析によって特定された最適なBNPカットオフは,<50 pg/mLでした.
結論:
- 90 pg/mLの"充血性心不全"のBNPカットオフ値は,急性PEの合併症のない経過を確実に予測することはできません.
- 低BNPカットオフ値<50pg/mLは,良性臨床経過を有する患者の95%を識別する.
- 低BNPレベルだけでは,急性PEの合併症のない入院を保証することはできません.
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