年龄休克指数联合N末端脑钠肽前体对急性肺栓塞短期预后的预测价值  

Value of age-based shock index combined with NT-proBNP in predicting the short-term prognosis of acute pulmonary embolism

作　　者：刘瑞雪 向波[2] 黄梦婷 张天聪 何菲[1] Liu Rui-xue;Xiang Bo;Huang Meng-ting;Zhang Tian-cong;He Fei(Department of Geriatrics,Yongchuan Hospital Affiliated to Chongqing MedicalUniversity,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院老年病科,重庆402160 [2]重庆医科大学附属永川医院放射科,重庆402160 [3]重庆医科大学附属永川医院中心实验室,重庆402160

出　　处：《中国急救医学》2022年第11期942-946,共5页Chinese Journal of Critical Care Medicine

基　　金：重庆市永川区科技局技术创新与应用发展专项(2021yc-cxfz30017)。

摘　　要：目的评价年龄休克指数(age-based shock index,SIA)联合N末端脑钠肽前体(N-terminal-pro-brain-natriuretic-peptide,NT-proBNP)对急性肺栓塞(acute pulmonary embolism,APE)患者短期预后的预测价值。方法回顾性分析2018年1月至2021年12月在重庆医科大学附属永川医院诊断为急性肺栓塞患者的临床资料,以确诊肺栓塞30 d生存情况为终点指标,比较不同分组的一般资料、休克指数(SI)、SIA、简化版肺栓塞严重程度指数(simplified pulmonary embolism severity index,sPESI)。联合SIA和NT-proBNP二元Logistic回归分析得到预后预测模型(SIA+NT-proBNP),应用Med-calc软件分别绘制受试者工作特征(receiver operating characteristic,ROC)曲线,并比较ROC曲线下面积(area under curve,AUC)以评估各指标对急性肺栓塞患者预后的预测价值。结果急性肺栓塞患者199例,其中存活176例(88.4%),男107例(60.8%),女69例(39.2%);死亡23例(11.6%),男15例(65.2%),女8例(34.8%)。死亡组SIA、NT-proBNP、SI、sPESI和下肢静脉血栓的发生率等均显著高于存活组,而收缩压、舒张压、动脉血氧饱和度均显著低于存活组,差异均有统计学意义(P<0.05);二元Logistic回归分析提示,SIA+NT-proBNP可被纳入预测模型;ROC曲线分析显示,sPESI的AUC为0.918(95%CI 0.871~0.952),SIA的AUC为0.912(95%CI 0.863~0.947),NT-proBNP的AUC为0.818(95%CI 0.757~0.869),SIA+NT-proBNP的AUC为0.944(95%CI 0.902~0.971)。结论SIA和NT-proBNP具有简单易行、准确性高的优点,二者对急性肺栓塞的预后预测均具有临床应用价值,其单独预测价值低于sPESI,但SIA联合NT-proBNP对急性肺栓塞短期预后的预测价值较sPESI更高。Objective To evaluate the value of age-based shock index(SIA)combined with N-terminal pro-brain natriuretic peptide(NT-proBNP)in predicting the short-term prognosis of patients with acute pulmonary embolism(APE).Methods The clinical data of patients with APE diagnosed in Yongchuan Hospital Affiliated to Chongqing Medical University from January 2018 to December 2021 were analyzed retrospectively.30-day survival after the diagnosis of pulmonary embolism was regarded as the endpoint.The general data,shock index(SI),SIA and simplified pulmonary embolism severity index(sPESI)in different groups were compared.The prognostic prediction model(SIA+NT-proBNP)was obtained by binary Logistic regression analysis.The receiver operating characteristic(ROC)curve were drawn by Med-calc software,and the areas under ROC curve(AUC)were compared to evaluate the predictive value of each index in predicting the prognosis of patients with APE.Results 199 patients with APE,176(88.4%)survived,including 107 males(60.8%)and 69 females(39.2%);23(11.6%)died,including 15 males(65.2%)and 8 females(34.8%).The SIA,NT-proBNP,SI,sPESI and the incidence of lower limb venous thrombosis in the death group were significantly higher than those in the survival group,while the systolic blood pressure,the diastolic blood pressure and arterial oxygen saturation in the death group were significantly lower than those in the survival group(P<0.05).Binary Logistic regression analysis indicated that SIA+NT-proBNP could be included in the prediction model.According to the ROC curve analysis drawn by Med-calc software,the AUC of sPESI was 0.918(95%CI 0.871-0.952),the AUC of SIA was 0.912(95%CI 0.863-0.947),the AUC of NT-proBNP was 0.818(95%CI 0.757-0.869),and the AUC of SIA+NT-proBNP was 0.944(95%CI 0.902-0.971).Conclusions SIA combined with NT-proBNP has the advantages of simplicity and high accuracy,both of them have clinical value in predicting the prognosis of APE,and predictive value of single indicator is lower than that of sPESI.

关 键 词：N末端脑钠肽前体(NT-proBNP) 年龄休克指数(SIA) 简化版肺栓塞严重程度指数(sPESI) 急性肺栓塞(APE) 短期预后 

分 类 号：R563.5[医药卫生—呼吸系统]