Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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The Prognostic Role of B-type Natriuretic Peptide in Acute Pulmonary Thromboembolism

급성 폐혈전색전증 환자에서 예후 인자로서 혈중 BNP의 의의

  • Lee, Su Jin (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Lee, Jae Hyung (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Park, Ji Young (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Jo, Woo Sung (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Kim, Ji Eun (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Kim, Ki Uk (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Park, Hye Kyung (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Kim, Yun Seong (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Lee, Min Ki (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Park, Soon Kew (Department of Internal Medicine, College of Medicine, Pusan National University)
  • 이수진 (부산대학교 의과대학 내과학교실) ;
  • 이재형 (부산대학교 의과대학 내과학교실) ;
  • 박지영 (부산대학교 의과대학 내과학교실) ;
  • 조우성 (부산대학교 의과대학 내과학교실) ;
  • 김지은 (부산대학교 의과대학 내과학교실) ;
  • 김기욱 (부산대학교 의과대학 내과학교실) ;
  • 박혜경 (부산대학교 의과대학 내과학교실) ;
  • 김윤성 (부산대학교 의과대학 내과학교실) ;
  • 이민기 (부산대학교 의과대학 내과학교실) ;
  • 박순규 (부산대학교 의과대학 내과학교실)
  • Received : 2006.03.22
  • Accepted : 2006.04.25
  • Published : 2006.05.30
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Abstract

Background : Vital stability and right side heart failure are major prognostic factors of acute pulmonary thromboembolism. While it is important to recognize right side heart failure, it is often difficult in real practice. Recently, several studies have described early diagnostic tools for detecting right side heart failure including echocardiography and biochemical markers. This study, we evaluated the prognostic role of the B-type natriuretic peptide (BNP) in an acute pulmonary thromboembolism. Methods : Thirty-four patients with a diagnosis of acute pulmonary thromboembolism were enrolled in the study. The BNP levels were measured and echocardiography was performed at the Emergency Department. Data on the prognostic factors including ventilatory support, vital stability, pulmonary artery pressure, degree of tricuspid valve regurgitation, complications and death was collected from the patients' medical records. The patients with an acute pulmonary thromboembolism were divided into two groups based on the vital stability and the BNP level and the cutoff values and prognostic factors of the two groups were compared. Results : The predictors of the vital stability that influence the prognosis of patients with acute pulmonary thromboembolism were the BNP level, ventilatory support and death. The plasma BNP levels showed a strong correlation with the vital stability, ventilatory support, thrombolytic therapy and death. When the BNP cutoff level was set to 377.5 pg/dl in a ROC curve, the sensitivity and the specificity for differentiating between the groups with stable or unstable vital signs was 100% and 90%, respectively. Conclusion : This study indicates that a measurement of the plasma BNP levels may be a useful prognostic marker in patients with an acute pulmonary thrombo-embolism.

연구배경: 폐혈전색전증은 혈역학적 안정성과 우심부전의 정도가 중요한 예후인자이다. 우심부전을 조기에 파악하는 것이 중요하지만 실제 임상에서는 판단이 쉽지 않은 경우가 많으므로 심초음파를 포함한 다양한 진단 방법이 연구되고 있다. 저자들은 급성폐혈전색전증의 예후 인자로서의 혈중 BNP를 평가하고자 하였다. 방 법: 2002년 1월부터 2005년 5월까지 부산대학교병원 응급실을 내원하여 급성 폐혈전색전증으로 진단된 환자중 BNP 검사와 심초음파 검사를 시행하였던 34명의 환자를 대상으로 의무기록을 검토하였다. 예후 예측인자로 중환자실 입실여부, 인공 환기 치료 유무, 활력징후의 안정성여부, 합병증의 동반, 사망여부, 심초음파의 폐동맥압력 값과 삼첨판막의 역류정도를 설정하여 혈중 BNP 농도와의 연관성을 평가하였고 혈역학적 안정성을 기준으로 두 군으로 나누어 두 군을 구분하는 BNP의 cutoff 값을 구하였다. 결 과: 활력징후의 안정성 여부, 우심실 수축기압과 삼첨판막의 역류 정도, 기계환기 시행여부, 사망여부가 혈중 BNP 농도와 통계적으로 유의한 상관관계를 보였으며 활력징후 안정성에 대한 다중회귀분석을 시행한 결과 사망, BNP 농도, 기계 환기 여부가 통계적 의의를 보였다. 활력징후 안정성을 기준으로 안정군과 불안정군으로 나눌때 양군의 분류를 위한 BNP 농도의 cut-off level은 377.5 pg/dl에서 가장 민감도와 특이도가 높았다. 결 론: 혈중 BNP는 여러 예후 예측인자들과 통계적으로 유의한 상관 관계를 보였고 측정이 쉽고 빠른 시간 내 결과를 확인할 수 있으므로 폐혈전색전증 환자의 우심부전 정도를 평가하기 위한 심초음파나 폐혈관 조영술등의 검사가 어려운 경우나 이 값들을 보정하는 경우에 있어서 유용한 예후 인자로 고려 할 수 있을 것으로 생각된다.

Keywords

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