D-二聚体和纤维蛋白原及CT肺动脉阻塞指数与肺栓塞危险程度的关系研究  

Relationship between D-dimer,Fibrinogen,CT Pulmonary Artery Occlusion Index and the Risk of Pulmonary Embolism

作　　者：刘萍[1] 曾强[2] 宋珊[3] 王丰[1] LIU Ping;ZENG Qiang;SONG Shan;WANG Feng(Department of Respiratory and Critical Medicine,Zigong Fourth People's Hospital,Zigong 643000,China;Department of Respiratory Medicine,the Third Hospital of Mianyang,Mianyang 621000,China;Department of Respiratory Medicine,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]四川省自贡市第四人民医院呼吸与危重症医学科,643000 [2]四川省绵阳市第三人民医院呼吸内科,621000 [3]川北医学院附属医院呼吸内科,四川省南充市637000

出　　处：《实用心脑肺血管病杂志》2020年第7期108-112,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的分析D-二聚体、纤维蛋白原(FIB)、CT肺动脉阻塞指数(CTI)与肺栓塞危险程度的相关性,并探讨上述指标对高危肺栓塞的预测价值。方法选取2017年2月—2019年9月在自贡市第四人民医院接受治疗的肺栓塞患者105例,根据肺栓塞危险程度分层分为高危组(n=14)、中危组(n=32)和低危组(n=59)。比较三组患者D-二聚体、FIB、CTI。D-二聚体、FIB、CTI与肺栓塞危险程度分层的相关性分析采用Spearman秩相关分析。绘制受试者工作特征曲线(ROC曲线)以分析D-二聚体、FIB、CTI及其联合检测对高危肺栓塞的预测价值。结果中危组、高危组患者D-二聚体、FIB、CTI高于低危组(P<0.05),高危组患者D-二聚体、FIB、CTI高于中危组(P<0.05)。Spearman秩相关分析结果显示,D-二聚体、FIB、CTI与肺栓塞危险程度分层均呈正相关(rs值分别为0.610、0.599、0.596,P<0.05)。ROC曲线分析显示,D-二聚体预测高危肺栓塞的最佳截断值为9.93 mg/L,ROC曲线下面积(AUC)为0.692〔95%CI(0.522,0.862)〕,灵敏度为64.29%,特异度为71.43%;FIB预测高危肺栓塞的最佳截断值为6.15 g/L,AUC为0.823〔95%CI(0.725,0.921)〕,灵敏度为64.29%,特异度为75.82%;CTI预测高危肺栓塞的最佳截断值为42.07%,AUC为0.806〔95%CI(0.681,0.931)〕,灵敏度为71.43%,特异度为78.02%;联合检测预测高危肺栓塞的灵敏度为92.86%,特异度为93.41%。结论D-二聚体、FIB、CTI均与肺栓塞危险程度呈正相关,且D-二聚体、FIB、CTI及其联合检测对高危肺栓塞患者均有一定的预测价值。Objective To analyze the relationship between D-dimer,fibrinogen(FIB),CT pulmonary artery occlusion index(CTI)and the risk of pulmonary embolism,and to explore the predictive value of the above indexes for highrisk patients with pulmonary embolism.Methods A total of 105 pulmonary embolism patients who were treated in Zigong Fourth People's Hospital from February 2017 to September 2019 were selected,and they were divided into high-risk group(n=14),intermediate-risk group(n=32)and low-risk group(n=59)according to the risk level of pulmonary embolism.The D-dimer,FIB and CTI in the three groups were compared.Spearman rank correlation was used to analyze the correlation between the D-dimer,FIB,CTI and risk stratification of pulmonary embolism.ROC curve was drawn to analyze the predictive value of D-dimer,FIB,CTI and their combined detection for high risk of pulmonary embolism.Results D-dimer,FIB and CTI in intermediaterisk group and high-risk group were statistically significantly higher than those in low-risk group(P<0.05),D-dimer,FIB and CTI in high-risk group were statistically significantly higher than those in intermediate-risk group(P<0.05).Spearman rank correlation results showed that D-dimer,FIB and CTI were positively correlated with the risk stratification of pulmonary embolism(rs value was 0.610,0.599 and 0.596,respectively,P<0.05).ROC curve analysis showed that the best cutoff value of D-dimer in predicting high risk of pulmonary embolism was 9.93 mg/L,AUC was 0.692〔95%CI(0.522,0.862)〕,sensitivity was 64.29%,specificity was 71.43%;the best cutoff value of FIB in predicting high risk of pulmonary embolism was 6.15 g/L,AUC was 0.823〔95%CI(0.725,0.921)〕,sensitivity was 64.29%,specificity was 75.82%;the best cutoff value of CTI in predicting high risk of pulmonary embolism was 42.07%,AUC was 0.806〔95%CI(0.681,0.931)〕,sensitivity was 71.43%,specificity was 78.02%;the sensitivity of the combined detection to predict high risk of pulmonary embolism was 92.86%,and the specificity was 93.41%.Conclusion

关 键 词：肺栓塞 危险分层 D-二聚体 纤维蛋白原 CT肺动脉阻塞指数 灵敏度 特异度 

分 类 号：R563.5[医药卫生—呼吸系统]