急性肺动脉栓塞患者血浆中D-二聚体水平与死亡率的相关性分析

Relationship between D-dimer level and mortality in acute pulmonary embolism

目的观察急性肺动脉栓塞患者(APE)血浆中的D-二聚体水平与死亡率的关系。方法记录2003～2007年在我院住院的PE患者的一般临床信息、主要实验室检查、主要治疗措施及临床转归情况。用比浊免疫测定法检测患者D-二聚体水平,随访3个月,记录预后情况。结果共入选113例患者,男51例(45.13%),平均63.22岁。3个月的总体死亡率为12.39%;D-二聚体的阳性检出率为96.46%,其中分布于500～2499μg/L、2500～4999μg/L和>5000μg/L3个区间的检出率分别为49.56%、26.55%和20.35%。与500～2499μg/L组相比,2500～4999μg/L组的患者死亡的风险是其2.01倍(95%CI1.03～3.99),≥5000μg/L组患者的风险是其3.02倍(95%CI1.78～5.89)。D-二聚体水平为随访患者3个月死亡的独立危险因素。结论 D-二聚体水平是患者预后的独立危险因素,可以帮助对APE患者进行危险分层及判断预后,具有重要的临床应用价值。

Objective To investigate the correlation between D-dimer levels and mortality of acute pulmonary embolism. Methods 113 patients with acute pulmonary embolism were recruited in our hospital between 2003 and 2007.The clinical information,laboratory examination,treatment measures and clinical outcome were recorded. The turbidimetric immunoassay method was used to determine the level of D-dimer in plasma. All patients underwent a clinical follow-up of 3 months. Results Among the 113 patients,aging 63.22 years in average,51（45.13%） were men. The general mortality rate was 12.39% after a follow-up of 3 months. The general positive detection rate of D-dimer was 96.46%,which in the 500-2499,2500-4999,5000μg/L group was 49.56%,26.55% and 20.35%,respectively. Compared to the 500-2499μg/L group,mortality in the 2500-4999μg/L group was increased by 1.91（95%CI 0.91-4.09）fold and that in the 5000μg/L group was increased by 2.94（95%CI 1.42-6.25）fold. D-dimer was an independent risk factor of death. Conclusion D-dimer level in pulmonary embolism is related to the clinical prognosis.