肺栓塞严重程度指数联合肌钙蛋白I对肺栓塞病情严重程度的预测价值  

Forecast value of combination of troponin I and pulmonary embolism severity index for severity in patients with pulmonary embolism

作　　者：段炜[1] 李嘉[1] 胡晓芸[1] 

机构地区：[1]山西医科大学第一医院呼吸科,太原030001

出　　处：《国际呼吸杂志》2012年第14期1062-1065,共4页International Journal of Respiration

基　　金：山西省卫生厅科技攻关计划项目（20100201）

摘　　要：目的探讨肺栓塞严重程度指数（PESI）联合肌钙蛋白I（cTnI）对肺栓塞（PE）病情严重程度的预测价值。方法回顾性分析山西医科大学第一医院呼吸科确诊后的245例PE患者，根据PESI评分、入院cTnI水平及两者联合进行分组，比较各组大、次大面积与非次大面积PE的发生率，评价以上指标单独与联合对PE病情严重性的预测价值。结果①PESⅠ分组Ⅰ级与Ⅱ级（低危组）均为非次大面积PE；Ⅲ级（中危组）非次大面积PE占42．5％，大、次大面积PE占57．5％；Ⅳ级与Ⅴ级（高危组）大、次大面积PE发生率分别为92．5％与100．0％。PESI评分高危组阳性预测值（PPV）为96．9％，特异度为95．2％，低危组阴性预测值（NPV）及敏感度均为100．0％。②cTnI阳性组大、次大面积发生率为98．2％，PPV为98．2％，特异度为36．5％。cTnI阴性组非次大面积PE发生率为94．1％，NPV为94．1％，敏感度为48．0％。③中危组联合cTnI阳性大、次大面积PE发生率为94．1％，PPV为94．1％，特异度为94．3％。结论PESI评分高危组对大、次大面积PE有较大的预测价值。单独应用cTnI预测PE病情严重性的临床价值不大，PESI评分联合cTnI测定较其单独应用的预测价值高。Objective To study the forecast value of combination of troponin I and pulmonary embolism severity index for severity in patients with pulmonary embolism （PE）. Methods The data of 245 patients with PE confirmed in the First Hospital of Shanxi Medical University. According to PESI, level of troponin I and combination of troponin I and PESI, the patients were divided into different groups. The incidence rates of non-massive, massive and sub-massive PE patients were compared. The forecast value of the PESI score,the level of troponin I and combination of troponin I and PESI for the severity in PE patients were evaluated. Results In the PESI classification, both class I and class II （low-risk group） were non-massive PE. In the class UI （intermediate-risk group） ,the non-massive PE accounted for 42.5% the massive and sub-massive PE accounted for 57.5%. The massive and sub-massive PE in the class IV and class V （high-risk group） respectively accounted for 92.5% and 100.0%. The positive predictive value （PPV） and specificity were respectively 96.9 %, 95.2 % in the high-risk group, while both the negative predictive value （NPV） and sensitivity were 100.0% in the low-risk group. The incidence rate of massive and sub-massive PE,PPV and specificity were respectively 98.2% ,98.2% and 36.5% in the group of negative troponin I, but incidence rate of non-massive PE, NPV and sensitivity were respectively 94.1%, 94.1% and 48.0%. The incidence rate of massive and sub-massive PE, PPV and specificity were respectively 94.1%, 94.1% and 94.3% in the combination of positive troponin I and intermediate-risk group. Conclusions The high-risk group has a higher predictive value for severity of massive and sub-massive PE. It has less predictive value for the severity of PE to use the level of troponin I than the combination of troponin I and PESI.

关 键 词：急性肺栓塞 肺栓塞严重程度指数 肌钙蛋白Ⅰ 

分 类 号：R563.5[医药卫生—呼吸系统]