中央型肺栓塞短期不良预后危险因素及Charlson合并症指数的预测价值  

Risk factors for short-term poor prognosis of central pulmonary embolism and the predictive value of Charlson comorbidities index

作　　者：刘云峰[1] 刘红艳[1] 孙静 刘颖 何琪圆 赵卉[1] Liu Yunfeng;Liu Hongyan;Sun Jing;Liu Ying;He Qiyuan;Zhao Hui(Dept of Respiratory,The Second Affiliated Hospital of Anhui Medical University,Hefei 230601)

机构地区：[1]安徽医科大学第二附属医院呼吸与危重症医学科,合肥230601

出　　处：《安徽医科大学学报》2024年第9期1643-1647,共5页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金面上项目(编号:81970051、82270071)。

摘　　要：目的探讨中央型肺栓塞(PE)患者短期不良预后危险因素及Charlson合并症指数(CCI)的预测价值。方法回顾性分析115例中央型PE患者,根据住院期间不良预后结果,将观察对象分为发生不良事件组和未发生不良事件组,分析不良事件组临床特征,对两组患者收集危险因素、CCI、血栓位置分组评分并进行单因素分析,对于有统计学意义的指标进行多因素Logistic回归分析。结果中央型PE患者临床症状以胸闷或呼吸困难最为常见(77.4%),其余依次为咳嗽(35.7%)、胸痛(28.7%)、晕厥(9.6%)、咯血(7.8%)。两组间性别、吸烟史、饮酒史、症状及体征差异无统计学意义;在单因素分析中,CCI、血栓位置分组评分、白细胞计数、中性粒细胞计数、尿素氮与中央型PE患者发生不良事件有关(P<0.05),多因素Logistic回归分析后,中性粒细胞计数升高(OR=1.494,95%CI:1.073~2.080,P=0.017)为独立危险因素(P<0.05)。发生不良事件组CCI高于未发生不良事件组(P=0.004),多因素分析显示CCI升高(OR=1.342,95%CI:1.022~1.763,P=0.034)为独立危险因素,且CCI每增加1分,发生不良事件风险增加34.2%。发生不良事件组血栓位置分组评分显著高于未发生不良事件组(OR=2.586,95%CI:1.366~4.896,P=0.004),且血栓位置分组评分每增加1分,发生不良事件风险增加1.586倍。结论中性粒细胞计数升高、CCI升高、血栓位置分组评分升高与中央型PE患者短期发生不良预后有关。Objective To investigate the risk factors of short-term adverse prognosis and the predictive value of Charlson comorbidities index(CCI)in patients with central pulmonary embolism(PE).Methods 115 cases of central PE patients were retrospectively analyzed.According to the adverse prognosis during hospitalization,the subjects were divided into adverse event group and no adverse event group.The clinical characteristics of the adverse event group were analyzed.Multivariate Logistic regression analysis was performed for statistically significant indicators.Results The most common clinical symptoms of central PE patients were chest distress or dyspnea(77.4%),followed by cough(35.7%),chest pain(28.7%),syncope(9.6%)and hemoptysis(7.8%).There were no statistically significant differences in gender,smoking history,drinking history,symptoms and signs between the two groups.In univariate analysis,CCI,grouping score of thrombus location,white blood cell count,neutrophil count and urea nitrogen were associated with adverse events in central PE patients,with statistical significance(P<0.05).After Logistic regression multivariate analysis,increased neutrophil count(OR=1.494,95%CI:1.073-2.080,P=0.017)was an independent risk factor(P<0.05).The CCI in the group with adverse events was higher than that in the group without adverse events(P=0.004).Multivariate analysis showed that increased CCI(OR=1.342,95%CI:1.022-1.763,P=0.034)was an independent risk factor,and the risk of adverse events increased by 34.2%for every one-point increase in CCI.The thrombus location score of the group with adverse events was significantly higher than that of the group without adverse events(OR=2.586,95%CI:1.366-4.896,P=0.004),and the risk of adverse events increased 1.586 times with each increase of thrombus location score.Conclusion Increased neutrophil count,CCI,and thrombus location score are associated with poor short-term prognosis in central PE patients.

关 键 词：中央型 肺栓塞 危险因素 不良预后 Charlson合并症指数 血栓位置 

分 类 号：R563.5[医药卫生—呼吸系统]