TIMI危险指数联合DFR对AECOPD伴急性肺栓塞患者危险分层及预后的评估价值  

Value of TIMI risk score combined with DFR in evaluating risk stratification and prognosis of AECOPD patients with acute pulmonary embolism

作　　者：张莹[1] 颜家华 孙鹏冲 张大伟 侯云坡 ZHANG Ying;YAN Jiahua;SUN Pengchong;ZHANG Dawei;HOU Yunpo(Department of Respiratory and Critical Illness,Fangshan Hospital of Beijing University of Chinese Medicine,Beijing 102400,China;不详)

机构地区：[1]北京中医药大学房山医院呼吸与危重症科,北京102400 [2]北京中医药大学房山医院重症医学科

出　　处：《山东医药》2022年第31期35-39,共5页Shandong Medical Journal

基　　金：北京市科技计划课题(Z181100003110045)。

摘　　要：目的 探讨心肌梗死溶栓治疗临床试验(TIMI)危险指数联合D-二聚体与纤维蛋白原比值(DFR)对慢性阻塞性肺疾病急性加重期(AECOPD)伴急性肺栓塞(APE)患者危险分层和预后的评估价值。方法 选择AECOPD伴APE患者160例(APE组)以及未伴APE的AECOPD患者67例(对照组);AECOPD伴APE患者根据APE危险分层分为低危组(42例)、中危组(63例)和高危组(55例),根据预后分为存活组133例和死亡组27例。入院后当日计算TIMI危险指数;采集各组空腹静脉血并分离血浆,用免疫比浊法检测D-二聚体,凝固法检测纤维蛋白原,计算DFR。多因素Logistic回归分析AECOPD伴APE患者预后的影响因素。绘制受试者工作特征曲线,分析TIMI危险指数、DFR预测AECOPD伴APE患者预后的价值。结果 APE组TIMI危险指数、D-二聚体、纤维蛋白原、DFR均高于对照组(P均<0.05)。高危组TIMI危险指数、D-二聚体、纤维蛋白原、DFR均高于中危组(P均<0.05),中危组以上指标均高于低危组(P均<0.05)。死亡组TIMI危险指数、D-二聚体、纤维蛋白原、DFR均高于存活组(P均<0.05)。高TIMI危险指数、DFR及合并休克是AECOPD伴APE患者住院期间死亡的危险因素(P均<0.05)。TIMI危险指数、DFR预测AECOPD伴APE患者预后的曲线下面积为0.833、0.815,高于D-二聚体、纤维蛋白原(P<0.05),TIMI危险指数+DFR预测AECOPD伴APE患者预后的曲线下面积为0.931,高于二者单独(P<0.05)。结论 AECOPD伴APE患者TIMI危险指数、DFR增高,且与APE危险分层以及预后不良有关,可作为AECOPD伴APE患者预后预测的指标。Objective To investigate the value of thrombolysis in myocardial infarction clinical trial(TIMI) risk score combined with D-dimer to fibrinogen ratio(DFR) in assessing risk stratification and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicated with acute pulmonary embolism(APE).Methods Totally 160 AECOPD patients with APE(APE group) and 67 AECOPD patients without APE(control group)were selected.According to APE risk stratification,APE group was then divided into the low risk group(n=42),medium risk group(n=63),and high risk group(n=55).According to the prognosis,they were divided into survival group of 133 cases and death group of 27 cases.TIMI risk score was calculated on the day after admission.On the day of admission,fasting venous blood was collected from two groups and plasma was separated.D-dimer level was detected by immunoturbidimetry,fibrinogen level was detected by coagulation,and DFR was calculated.Multivariate Logistic regression analysis was used to analyze the factors influencing the prognosis of AECOPD patients with APE.We analyzed the prognostic value of TIMI risk score and DFR in AECOPD patients with APE by drawing the receiver operating characteristic curve.Results TIMI risk score,D-dimer,fibrinogen and DFR of the APE group were higher than those of control group(all P<0.05),TIMI risk score,D-dimer,fibrinogen and DFR of the high risk group were higher than those of medium risk group(all P<0.05),and those in the medium risk group were higher than those of the low risk group(all P<0.05).The TIMI risk score,D-dimer,fibrinogen and DFR of the death group were higher than those of the survival group(all P<0.05).The high TIMI risk score,DFR and shock were risk factors for the death of AECOPD patients with APE during hospitalization(all P<0.05).The area under the curve of TIMI risk score and DFR in predicting the prognosis of AECOPD patients with APE was 0.833 and 0.815,which were higher than that of D-dimer and fibrinogen(all P<0.05).The area under

关 键 词：慢性阻塞性肺疾病 急性加重期 急性肺栓塞 危险分层 预后 心肌梗死溶栓治疗临床试验 D-二聚体 纤维蛋白原 

分 类 号：R563[医药卫生—呼吸系统]