急性肺栓塞预后因素分析及模型建立  

Establishment and evaluation of a prognostic modal for acute pulmonary embolism

作　　者：许能銮[1] 薛鸿[1] 陈愉生[1] 李鸿茹[1] 洪如钧[1] 

机构地区：[1]福建医科大学省立临床医学院福建省立医院呼吸内科,福州350001

出　　处：《中华结核和呼吸杂志》2016年第4期304-310,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：福建省自然科学基金（2015J05143）;福建省卫生和计划生育委员会青年科研课题（2015-2-4）

摘　　要：目的 探讨影响急性肺栓塞预后的因素,并建立预后判别模型.方法 回顾2007年1月1日至2013年9月30日福建省立医院收治的331例急性肺栓塞患者的临床资料,其中男141例,女190例,年龄9～ 87岁,平均（62±11）岁.采用单因素分析和多因素logistic回归分析的方法获得独立预后因素,并建立预后判别模型.结果 经单因素分析,对肺栓塞预后影响有统计学意义的指标包括糖尿病、三尖瓣区收缩期杂音、体温、呼吸、天冬氨酸氨基转移酶、甘油三酯、心电图异常、机械通气、肺栓塞危险分层、住院期间发生循环衰竭、使用低分子量肝素及华法林钠（均P＜0.05）.多因素logistic回归分析显示肺栓塞独立预后因素为：近期（1个月内）手术或骨折（OR值为4.12,95％ CI：1.07～ 15.86）、三尖瓣区收缩期杂音（OR值为15.58,95％ C1：3.11 ～78.18）、甘油三酯增高（OR值为7.81,95％ CI：2.21～ 27.61）、住院期间休克（OR值为7.67,95％ CI：2.24～ 26.19）、机械通气（OR值为35.48,95％ CI：4.75～ 265.09）及联合应用低分子量肝素与华法林钠（OR值为0.15,95％ CI：0.04 ～0.49）.以分组变量预后情况（y）表明预后分类,6项变量为：三尖瓣区收缩期杂音（x1）、甘油三酯增高（x2）、住院期间循环衰竭（x3）、联合应用低分子量肝素与华法林钠（x4）、机械通气（x5）和近期（1个月内）手术或骨折（x6）,建立Fisher函数：y=0.144＋1.266x1＋0.869x2＋1.794x3-0.517x4 ＋3.555x5 ＋0.661x6.回代检验显示该函数总判别正确率为93.0％.结论 近期（1个月内）手术或骨折、伴有三尖瓣区收缩期杂音、甘油三酯增高、住院期间休克及应用机械通气的肺栓塞患者是发生不良预后的高危人群,联合应用低分子量肝素与华法林钠的治疗方案有助于改善患者的预后,基于此建立的判别函数可帮助临床预测肺动脉栓塞患者的预后.Objective To identify the factors influencing the prognosis of patients with acute pulmonary embolism（PE） and to establish a prognostic model.Methods The clinical data of 331 patients （141 males and 190 females,aged 9 to 87 years） with acute PE in Fujian Hospital from January 2007 to September 2013 were analyzed.Univariate analysis and logistic regression analysis were used for selecting the independent prognostic factors for acute PE.Based on logistic regression analysis,a prognostic model for PE was established.Results Univariate analysis showed that statistically significant （all P 〈 0.05） factors influencing the prognosis of PE were diabetes,tricuspid systolic murmur,body temperature,respiratory rate,heart rate,aspartate aminotransferase,triglycerides,abnormal ECG,mechanical ventilation,circulatory failure during hospitalization,risk stratification of PE,types of treatment,and use of low-molecular-weight heparin and Warfarin.Logistic regression analysis showed that recent （〈 1 month） operation or fracture,tricuspid systolic murmur,high triglyceride level,circulatory failure during hospitalization and mechanical ventilation were independent factors for poor prognosis of PE,while combined use of low-molecular-weight heparin and Warfarin was a protective factor for the prognosis of PE.The Fisher prognostic model equation was y =0.144 ＋ 1.266x1 ＋ 0.869x2 ＋ 1.794x3-0.517x4 ＋ 3.555x5 ＋ 0.661x6.The accuracy of the Fisher discriminant function was 93.0%.Conclusion Recent （〈 1 month） operation or fracture,tricuspid systolic murmur,high triglyceride level,shock during hospitalization and mechanical ventilation were signs of poor prognosis for PE,while combined use of low-molecular-weight heparin and Warfarin were beneficial for the prognosis.The discriminant function based on these data can be helpful for predicting the prognosis of patients with PE.

关 键 词：肺栓塞 预后 诊断 

分 类 号：R563.5[医药卫生—呼吸系统]