血清D-二聚体与纤维蛋白原比值联合血清NT-proBNP水平对急性肺栓塞患者预后的预测价值

Predictive value of DFR combined with serum NT-proBNP level for the prognosis of patients with acute pulmonary embolism

目的探讨血清D-二聚体/纤维蛋白原比值(DFR)联合N末端脑钠肽前体(NT-proBNP)对急性肺栓塞患者预后的预测价值。方法采用回顾性研究,将2019年1月至2022年12月河北北方学院附属第一医院收治的急性肺栓塞患者作为研究对象。共入组108例患者,按30 d预后情况将其分为死亡组(n=29)与存活组(n=79)。比较两组血清D-二聚体、纤维蛋白原、DFR、NT-proBNP水平等临床资料差异;采用多因素Logistic回归分析影响急性肺栓塞患者预后的因素;采用受试者操作特征(ROC)曲线评定血清DFR、NT-proBNP水平对急性肺栓塞患者预后的价值。结果死亡组年龄为(72.87±11.25)岁,大于存活组[(66.47±12.46)岁],差异有统计学意义(P<0.05),两组其他一般资料比较,差异均无统计学意义(P>0.05)。死亡组的血清hs-CRP、D-二聚体、纤维蛋白原、DFR及NT-proBNP水平分别为(4.51±1.36)mg/L、(1.05±0.29)mg/L、(5.14±1.21)g/L、0.25±0.08、(2084.51±619.74)ng/L,均高于存活组[(3.84±1.21)mg/L、(0.81±0.22)mg/L、(4.54±0.78)g/L、0.18±0.05、(1547.46±413.69)ng/L],差异均有统计学意义(P<0.05);两组白细胞、中性粒细胞等比较,差异均无统计学意义(P>0.05)。Logistic回归分析,得出年龄较大、较高DFR及NT-proBNP水平是急性肺栓塞患者30 d死亡的危险因素(OR=2.389,95%CI:1.194~4.782;OR=1.906,95%CI:1.236~2.939;OR=1.610,95%CI:1.129~2.295;P<0.05)。ROC曲线分析得出,血清DFR、NT-proBNP均对急性肺栓塞患者30 d死亡有一定预测能力,其AUC分别为0.828、0.763,二者联合的AUC达到0.907。结论血清DFR、NT-proBNP水平与急性肺栓塞患者30 d预后相关,均可作为患者30 d死亡的预测标志物。

Objective To investigate the prognostic value of serum D-dimer/fibrinogen ratio(DFR)combined with N-terminal pro-brain natriuretic peptide(NT-proBNP)in patients with acute pulmonary embolism.Methods Patients with acute pulmonary embolism admitted to the First Affiliated Hospital of Hebei North University from January 2019 to December 2022 were included in this study.A total of 108 patients were enrolled and divided into the death group(n=29)and the survival group(n=79)according to the 30-day prognosis.The clinical data such as serum D-dimer,fibrinogen,DFR and NT-proBNP levels were compared between the two groups.The factors affecting the prognosis of patients with acute pulmonary embolism were analyzed using multivariate Logistic regression analysis;and the prognostic predictive ability of serum DFR and NT proBNP levels was evaluated by receiver operating characteristic(ROC).Results The age of the death group was(72.87±11.25)years,which was higher than that of the survival group[(66.47±12.46)years],and the difference was statistically significant(P<0.05);there were no statistically significant differences in other general information between the two groups(P>0.05).The serum hs-CRP,D-dimer,fibrinogen,DFR,and NT-proBNP levels in the death group were(4.51±1.36)mg/L,(1.05±0.29)mg/L,(5.14±1.21)g/L,0.25±0.08,and(2084.51±619.74)ng/L,respectively,which were higher than those in the survival group[(3.84±1.21)mg/L,(0.81±0.22)mg/L,(4.54±0.78)g/L,0.18±0.05,and(1547.46±413.69)ng/L],and the differences were statistically significant(P<0.05);there were no statistically significant differences between the two groups of white blood cells,neutrophils,etc.(P>0.05).Logistic regression analysis showed that older age,higher DFR and NT-proBNP level were risk factors for 30-day death in patients with acute pulmonary embolism(OR=2.389,95%CI:1.194-4.782;OR=1.906,95%CI:1.236-2.939;OR=1.610,95%CI:1.129-2.295;P<0.05).ROC curve analysis showed that serum DFR and NT-proBNP had certain predictive ability for 30-day death of APE patients,with AUC of 0.828 and 0.763,respectively,and the combined AUC of the two reached 0.907.Conclusion Serum DFR and NT-proBNP levels are related to the 30-day prognosis of acute pulmonary embolism patients,and can be used as predictive markers for 30-day death.