B型利钠肽对急性肺栓塞预后预测价值的Meta分析_《中国循证医学杂志》

作者：

檀旦 ,  赵玉虹 , 黄亚明

中国医科大学信息管理与信息系统（医学）系（沈阳?110001）;

关键词：

利钠肽脑肺栓塞 Meta分析

DOI：

10.7507/1672-2531.20110012

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　探讨B型利钠肽（B-type natriuretic peptide，BNP）对急性肺栓塞（acute pulmonary embolism，APE）患者短期全死因死亡的预测价值。
方法　计算机检索PubMed、EMbase、Cochrane图书馆临床对照试验资料库、CBM网络版和CNKI等数据库，检索时间均从建库至2010年3月，收集BNP和N-终端前BNP（N-terminal pro-B-type natriuretic peptide，NT-proBNP）水平升高对APE患者预后影响的队列研究，对符合纳入标准的临床研究进行质量评价和资料提取后，采用RevMan 5.0和MetaDisc软件进行Meta分析。
结果　共纳入16项研究，合计1 126例患者。9个研究报道了BNP水平，7个研究报道了NT-proBNP水平，各组间异质性较小（P=0.94，I2=0；P=0.99，I2=0），且无临床异质性，故将BNP或NT-proBNP升高视为同一结果。Meta分析结果显示：BNP或NT-proBNP水平升高对于短期全死因死亡预测价值的SEN合并为0.89，SPE合并为0.52，+LR合并为1.87，–LR合并为0.20，PPV为0.16，NPV为0.98，SROC 曲线下面积为 0.830 5，SE（AUC）=0.033 5。
结论　BNP水平升高可以帮助鉴别死亡率高的急性肺栓塞患者，而BNP水平正常的患者阴性预测值高则有助于医生识别出那些不良事件发生可能性较低的患者，以便有选择性地进行患者随访。

引用本文： 檀旦,赵玉虹,黄亚明. B型利钠肽对急性肺栓塞预后预测价值的Meta分析. 中国循证医学杂志, 2011, 11(1): 64-69. doi: 10.7507/1672-2531.20110012 复制

1.	李德新, 贾慧敏, 王清涛. BNP的测定和临床应用的研究进展. 现代生物医学进展, 2006, 6(10): 139-142.
2.	Sudoh T, Kangawa K, Minamino N, et al. A new natriuretic peptide in porcine brain. Nature, 1988, 332(6159): 78-81.
3.	苏哲坦. 脑钠利尿肽临床应用的进展及其争论. 海南医学院学报, 2005, 11(5): 438-441.
4.	谷国强. 急性肺栓塞患者危险分层的生物学指标. 国际心血管病杂志, 2006, 33(2): 110-113.
5.	Cavallazzi R, Nair A, Vasu T, et al. Natriuretic peptides in acute pulmonary embolism: a systematic review. Intensive Care Med, 2008, 34(12): 2147-56.
6.	Coutance G, Le Page O, Lo T, et al. Prognostic value of brain natriuretic peptide in acute pulmonary embolism. Crit Care, 2008, 12(4): R109. Epub 2008 Aug 22.
7.	Kucher N, Printzen G, Goldhaber SZ. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Circulation, 2003, 107: 2545-2547.
8.	Ten Wolde M, Tulevski II, Mulder JW. Brain natriuretic peptide as a predictor of adverse outcome in patients with pulmonary embolism. Circulation, 2003, 107: 2082-2084.
9.	Pieralli F, Olivotto I, Vanni S, et al. Usefulness of bedside testing for brain natriuretic peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism. Am J Cardiol, 2006, 97: 1386-1390.
10.	Krüger S, Graf J, Merx MW, et al. Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism. Am Heart J, 2004, 147: 60-65.
11.	Tulevski II, ten Wolde M, van Veldhuisen DJ, et al. Combined utility of brain natriuretic peptide and cardiac troponin T may improve rapid triage and risk stratification in normotensive patients with pulmonary embolism. Int J Cardiol, 2007, 116: 161-166.
12.	Logeart D, Lecuyer L, Thabut G, et al. Biomarker-based strategy for screening right ventricular dysfunction in patients with nonmassive pulmonary embolism. Intensive Care Med, 2007, 33: 286-292.
13.	Ray P, Maziere F, Medimagh S, et al. Evaluation of B-type natriuretic peptide to predict complicated pulmonary embolism in patients aged 65 years and older: brief report. Am J Emerg Med, 2006, 24: 603-607.
14.	杜林林, 邱俏檬, 卢中秋, 等. BNP在急性肺栓塞中的变化及意义. 医学研究杂志, 2007, 36(3): 46-48.
15.	李炳华, 王惠阁, 张金卓, 等. 脑钠肽和肌钙蛋白I联合检测对急性肺栓塞预后评估的意义. 临床医药, 2007, 16(23): 54-55.
16.	Pruszczyk P, Kostrubiec M, Bochowicz A, et al. N-terminal pro-brain natriuretic peptide in patients with acute pulmonary embolism. Eur Respir J, 2003, 22: 649-653.
17.	Kucher N, Printzen G, Doernhoefer T, et al. Low pro-brain natriuretic peptide levels predict benign clinical outcome in acute pulmonary embolism. Circulation, 2003, 107: 1576-1578.
18.	Kostrubiec M, Pruszczyk P, Bochowicz A, et al. Biomarker-based risk assessment model in acute pulmonary embolism. Eur Heart J, 2005, 26: 2166-2172.
19.	Binder L, Pieske B, Olschewski M, et al. N-terminal pro-brain natriuretic peptide or troponin testing followed by echocardiography for risk stratification of acute pulmonary embolism. Circulation, 2005, 112: 1573-1579.
20.	Maziere F, Birolleau S, Medimagh S, et al. Comparison of troponin I and N-terminal-pro Btype natriuretic peptide for risk stratification in patients with pulmonary embolism. Eur J Emerg Med, 2007, 14: 207-211.
21.	Alonso-Martínez JL, Urbieta-Echezarreta M, Anniccherico-Sánchez FJ, et al. N-Terminal Pro-B-Type Natriuretic Peptide Predicts the Burden of Pulmonary Embolism. Am J Med Sci, 2009, 337(2): 88-92.
22.	Kostrubiec M, Pruszczyk P, Kaczynska A, et al. Persistent NT-proBNP elevation in acute pulmonary embolism predicts early death. Clin Chim Acta, 2007, 382(1-2): 124-128.
23.	Becattini C, Cristina Vedovati M, et al. Prognostic value of troponins in acute pulmonary embolism. Circulation, 2007, 116: 427-433.

1. 李德新, 贾慧敏, 王清涛. BNP的测定和临床应用的研究进展. 现代生物医学进展, 2006, 6(10): 139-142.
2. Sudoh T, Kangawa K, Minamino N, et al. A new natriuretic peptide in porcine brain. Nature, 1988, 332(6159): 78-81.
3. 苏哲坦. 脑钠利尿肽临床应用的进展及其争论. 海南医学院学报, 2005, 11(5): 438-441.
4. 谷国强. 急性肺栓塞患者危险分层的生物学指标. 国际心血管病杂志, 2006, 33(2): 110-113.
5. Cavallazzi R, Nair A, Vasu T, et al. Natriuretic peptides in acute pulmonary embolism: a systematic review. Intensive Care Med, 2008, 34(12): 2147-56.
6. Coutance G, Le Page O, Lo T, et al. Prognostic value of brain natriuretic peptide in acute pulmonary embolism. Crit Care, 2008, 12(4): R109. Epub 2008 Aug 22.
7. Kucher N, Printzen G, Goldhaber SZ. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Circulation, 2003, 107: 2545-2547.
8. Ten Wolde M, Tulevski II, Mulder JW. Brain natriuretic peptide as a predictor of adverse outcome in patients with pulmonary embolism. Circulation, 2003, 107: 2082-2084.
9. Pieralli F, Olivotto I, Vanni S, et al. Usefulness of bedside testing for brain natriuretic peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism. Am J Cardiol, 2006, 97: 1386-1390.
10. Krüger S, Graf J, Merx MW, et al. Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism. Am Heart J, 2004, 147: 60-65.
11. Tulevski II, ten Wolde M, van Veldhuisen DJ, et al. Combined utility of brain natriuretic peptide and cardiac troponin T may improve rapid triage and risk stratification in normotensive patients with pulmonary embolism. Int J Cardiol, 2007, 116: 161-166.
12. Logeart D, Lecuyer L, Thabut G, et al. Biomarker-based strategy for screening right ventricular dysfunction in patients with nonmassive pulmonary embolism. Intensive Care Med, 2007, 33: 286-292.
13. Ray P, Maziere F, Medimagh S, et al. Evaluation of B-type natriuretic peptide to predict complicated pulmonary embolism in patients aged 65 years and older: brief report. Am J Emerg Med, 2006, 24: 603-607.
14. 杜林林, 邱俏檬, 卢中秋, 等. BNP在急性肺栓塞中的变化及意义. 医学研究杂志, 2007, 36(3): 46-48.
15. 李炳华, 王惠阁, 张金卓, 等. 脑钠肽和肌钙蛋白I联合检测对急性肺栓塞预后评估的意义. 临床医药, 2007, 16(23): 54-55.
16. Pruszczyk P, Kostrubiec M, Bochowicz A, et al. N-terminal pro-brain natriuretic peptide in patients with acute pulmonary embolism. Eur Respir J, 2003, 22: 649-653.
17. Kucher N, Printzen G, Doernhoefer T, et al. Low pro-brain natriuretic peptide levels predict benign clinical outcome in acute pulmonary embolism. Circulation, 2003, 107: 1576-1578.
18. Kostrubiec M, Pruszczyk P, Bochowicz A, et al. Biomarker-based risk assessment model in acute pulmonary embolism. Eur Heart J, 2005, 26: 2166-2172.
19. Binder L, Pieske B, Olschewski M, et al. N-terminal pro-brain natriuretic peptide or troponin testing followed by echocardiography for risk stratification of acute pulmonary embolism. Circulation, 2005, 112: 1573-1579.
20. Maziere F, Birolleau S, Medimagh S, et al. Comparison of troponin I and N-terminal-pro Btype natriuretic peptide for risk stratification in patients with pulmonary embolism. Eur J Emerg Med, 2007, 14: 207-211.
21. Alonso-Martínez JL, Urbieta-Echezarreta M, Anniccherico-Sánchez FJ, et al. N-Terminal Pro-B-Type Natriuretic Peptide Predicts the Burden of Pulmonary Embolism. Am J Med Sci, 2009, 337(2): 88-92.
22. Kostrubiec M, Pruszczyk P, Kaczynska A, et al. Persistent NT-proBNP elevation in acute pulmonary embolism predicts early death. Clin Chim Acta, 2007, 382(1-2): 124-128.
23. Becattini C, Cristina Vedovati M, et al. Prognostic value of troponins in acute pulmonary embolism. Circulation, 2007, 116: 427-433.

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B型利钠肽对急性肺栓塞预后预测价值的Meta分析

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《中国循证医学杂志》

B型利钠肽对急性肺栓塞预后预测价值的Meta分析

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