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目的:观察瑞替普酶对急性肺栓塞(APE)患者溶栓治疗的临床疗效及溶栓前后血浆N端B型尿钠肽前体(NT-proBNP)水平的变化及其临床意义。方法:42例符合溶栓治疗条件的APE患者给予瑞替普酶18mg+18mg静脉溶栓治疗,分别观察溶栓前及溶栓6h后患者临床表现、血浆NT-proBNP、肌钙蛋白T(cTnT)水平,溶栓12～24h复查超声心动图、CT肺动脉成像或核素肺灌注显像,评价临床疗效。结果:血管再通患者37例(88.1%),其NT-proBNP浓度和肺动脉压力均较溶栓前显著下降[(8 672.4±201.7)pg/ml︰(1 559.8±23.5)pg/ml,(52.82±17.34)mmHg︰(38.13±12.32)mmHg,1mmHg=0.133kPa;均P<0.01)],且NT-proBNP浓度下降幅度与肺动脉压下降幅度、右心室/左心室比值密切相关(r分别为0.61、0.54);溶栓前后cTnT水平差异无统计学意义。血管未通患者5例,其溶栓前后NT-proBNP、cTnT及肺动脉压力差异无统计学意义。结论:瑞替普酶对APE患者进行静脉溶栓治疗有较好的临床疗效和安全性,且动态检测NT-proBNP浓度可作为评价溶栓再灌注成功与否的有效指标。
Objective: To observe the clinical effect of reteplase on thrombolysis in patients with acute pulmonary embolism (APE) and the change of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level before and after thrombolysis and its clinical significance. Methods: Forty-two APE patients undergoing thrombolytic therapy were treated with reteplase 18 mg and 18 mg intravenous thrombolysis. The clinical manifestations, plasma NT-proBNP, troponin T (cTnT ) Levels, thrombolysis 12 ~ 24h review echocardiography, CT pulmonary artery imaging or radionuclide imaging, evaluation of clinical efficacy. Results: Thirty-seven patients (88.1%) with revascularization had significantly lower NT-proBNP concentration and pulmonary artery pressure than those before thrombolysis (8 672.4 ± 201.7 pg / ml: (1 559.8 ± 23.5) pg / ml, 52.82 ± 17.34) mmHg: (38.13 ± 12.32) mmHg, 1mmHg = 0.133kPa; all P <0.01), and the decrease of NT-proBNP concentration was closely related to the decrease of pulmonary arterial pressure and the ratio of right ventricle to left ventricle 0.61,0.54). There was no significant difference in cTnT level before and after thrombolysis. There were 5 cases of unacceptable blood vessels, and there was no significant difference in NT-proBNP, cTnT and pulmonary artery pressure before and after thrombolysis. CONCLUSION: Reteplase has a good clinical efficacy and safety in intravenous thrombolytic therapy for patients with APE, and the dynamic detection of NT-proBNP concentration can be used as an effective index to evaluate the success of thrombolysis-reperfusion.