心脏肌钙蛋白Ⅰ和氧合指数联合指标对急性中高危肺血栓栓塞症不良预后的预测分析  

Combined analysis of cardiac troponin I and oxygenation indexes for predicting adverse prognosis of acute intermediate-high-risk pulmonary thromboembolism

作　　者：李玲姣 石莉芳 彭优 欧阳雯 佘志远 郑昭芬[2] 江刚[1] LI Ling-jiao;SHI Li-fang;PENG You;OU Yang-wen;SHE Zhi-yuan;ZHENG Zhao-fen;JIANG Gang(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Hunan Normal University,Hunan Provincial People′s Hospital,Changsha,Hunan 410005,China;Department of Cardiology,the First Affiliated Hospital of Hunan Normal University,Hunan Provincial People′s Hospital,Changsha,Hunan 410005,China;Department of Respiratory and Critical Care Medicine,Changsha Eighth Hospital,Changsha,Hunan 410000,China;Department of Infection,Hunan Want Want Hospital,Changsha,Hunan 410005,China)

机构地区：[1]湖南师范大学第一附属医院(湖南省人民医院)呼吸与危重症医学科,湖南长沙 [2]湖南师范大学第一附属医院(湖南省人民医院)心血管内科,湖南长沙410005 [3]长沙市第八医院呼吸与危重症医学科,湖南长沙410000 [4]长沙市旺旺医院感染科,湖南长沙410005

出　　处：《临床肺科杂志》2023年第6期874-879,共6页Journal of Clinical Pulmonary Medicine

基　　金：湖南省重点研发计划(No.2019SK2021);湖南省卫生和计划生育委员会重点项目(No.20200339)。

摘　　要：目的探讨影响急性中高危肺血栓栓塞症(PTE)患者抗凝治疗近期不良结局的因素。方法回顾性分析湖南省人民医院2019年1月至2022年1月72例急性中高危PTE患者的临床资料,根据抗凝治疗30天内是否出现不良后果,将患者分为不良结局组和良好结局组,收集所有患者治疗前的实验室数据及临床资料,采用二元Logistic回归分析急性中高危PTE不良结局的独立危险因素;用受试者工作特征曲线(ROC)分析各独立危险因素对急性中高危PTE不良结局的预测能力。结果不良结局组患者30例,男16例,女14例,平均年龄(63.60±10.41)岁;良好结局组患者42例,男21例,女21例,平均年龄(63.83±9.63)岁,两组患者的年龄和性别构成比差异无统计学意义(P>0.05)。心悸和晕厥症状以及伴随疾病易栓症在不良结局和良好结局组之间具有统计学差异(P<0.05)。30天内发生不良后果亚组患者的心率、呼吸频率、休克指数、修正休克指数、氧合指数、D-二聚体、cTnI、NT-proBNP、CTPA和超声心动图RV和RV/LV比值、主肺动脉内径和三尖瓣反流速度与良好结局组患者比较差异显著,具有统计学意义(P<0.05)。单因素二元Logistic回归分析结果表明氧合指数[OR=1.05,95%CI(1.013~1.087)]和cTnI[OR=0.031,95%CI(0~0.487)]是急性中高危PTE预后不良的危险因子(P<0.05)。氧合指数和cTnI联合指标的ROC曲线下面积为0.987,cut-off值为0.618,灵敏度为93.80%,特异度为92.90%,阴性预测值为93.744%,阳性预测值为92.963%。结论cTnI和氧合指数联合指标是预测急性中高危PTE抗凝治疗不良结局的独立预测因子,为急性中高危PTE的早期积极治疗提供参考价值。Objective To investigate the factors influencing the short-term adverse outcomes of anticoagulant therapy for patients with acute intermediate-high-risk pulmonary thromboembolism(PTE).Methods The clinical data of 72 patients with acute intermediate-high-risk PTE admitted in Hunan Provincial People′s Hospital from January 2019 to January 2022 were retrospectively analyzed.According to whether adverse outcomes occurred within 30 days of anticoagulation treatment,the patients were divided into the adverse outcome group and the good outcome group.The clinical data of all patients before treatment were collected.Binary logistic regression was used to analyze the independent risk factor for adverse outcomes of acute intermediate-high-risk PTE.Receiver operating characteristic(ROC)was used to analyze the independent predictor of adverse outcomes.Results There were 30 patients in the adverse outcome group,including 16 males and 14 females with an average age of(63.60±10.41)years,and 42 patients in the good group,including 21 males and 21 females with an average age of(63.83±9.63)years.There was no significant difference in age and sex composition between the two groups(P>0.05).Cardiopalmus,syncope symptom and thromboembolic comorbidities were significantly different between the two groups(P<0.05).Heart rate,respiratory rate,shock index,modified shock index,oxygenation index,D-dimer,cTnI,NT-proBNP,CTPA and echocardiography RV and RV/LV ratio,main pulmonary artery diameter and tricuspid regurgitation rate of the patients with adverse outcomes in 30 days were significantly different from those in the good outcome group(P<0.05).Logistic regression analysis showed that oxygenation index[OR=1.05,95%CI(1.013~1.087)]and TnI[OR=0.031,95%CI(0~0.487)]were the risk factors for poor prognosis of acute intermediate-high-risk PTE(P<0.05).The area under ROC curve of oxygenation index and cTnI combined index was 0.987,cut-off value was 0.618,sensitivity was 93.80%,specificity was 92.90%,positive predictive value was 92.963%,and negat

关 键 词：肺血栓栓塞症 心脏肌钙蛋白I 氧合指数 

分 类 号：R563.5[医药卫生—呼吸系统]