肺栓塞严重指数在非高危急性肺血栓栓塞症中的临床价值

Clinical value of pulmonary embolism severity index in non high-risk acute pulmonary thromboembolism

目的 对接受序贯抗凝治疗的非高危急性肺血栓栓塞症患者进行肺栓塞严重指数（PESI）评分,评价PESI评分在这一类患者中的临床价值.方法 按照PESI评分的不同将接受序贯抗凝治疗的非高危急性肺血栓栓塞症患者分为高评分组和低评分组.比较两组不良事件的发生率和疗效.结果 高评分组患者82例,低评分组患者76例.高评分组不良事件发生率为23.2％（19/82）,低评分组为7.9％（6/76）,两组比较差异有统计学意义（P=0.009）,高评分组不良风险序贯抗凝治疗30 d累积风险也显著高于低评分组,差异有统计学意义（P＜0.05）.PESI评分预测不良事件发生的敏感度为76.0％,特异度为52.6％,阳性预测值为64.6％,阴性预测值为65.9％.高评分组的病死率为9.8％（8/82）,低评分组为1.3％（1/76）,两组比较差异有统计学意义（P=0.022）.序贯抗凝治疗30 d后高评分组和低评分组患者肺动脉收缩压分别为（39.4±8.1）、（27.2±5.5） mm Hg（1 mm Hg=0.133 kPa）,右室内径分别为（33.0±7.8）、（21.7±4.6） mm,动脉血氧分压分别为（75.15±12.41）、（86.36±9.22） mm Hg,两组比较差异有统计学意义（P=0.034、0.021、0.016）.结论 PESI评分可有效预测接受序贯抗凝治疗的非高危急性肺血栓栓塞症患者的短期疗效和预后.这一类患者中至少有一部分可能需要序贯抗凝以外的治疗.

Objective To evaluate the clinical value of pulmonary embolism severity index （PESI） in non high-risk acute pulmonary thromboembolism （APTE） patients treated with sequential anticoagulation.Methods Non high-risk APTE patients treated with sequential anticoagulation were divided into two groups according to PESI：high-value group and low-value group.Prognosis and treatment response was compared between two groups.Results There were 82 cases in high-value group,and 76 cases in low-value group.The rate of adverse events in high-value group was significantly higher than that in low-value group [23.2%（19/82） vs.7.9% （6/76）] （x2 =5.0698,P =0.009）,and 30 days cumulative hazard was also significantly higher than that in low-value group （P 〈 0.05）.The sensitivity of predicting adverse events by PESI was 76.0%,specificity was 52.6%,positive predicting value was 64.6%,and negative predicting value was 65.9%.The mortality in high-value group was significantly higher than that in low-value group [9.8%（8/82） vs.1.3% （1/76）] （P =0.022）.After 30 days of anticoagulation,the pulmonary artery systolic pressure,internal diameter of right ventricle in high-value group was significantly higher than that in low-value group [（39.4 ± 8.1） mm Hg （1 mm Hg =0.133 kPa） vs.（27.2 ± 5.5） mm Hg,（33.0 ± 7.8） mm vs.（21.7 ± 4.6） mm] （P =0.034,0.021）,and arterial oxygen partial pressure was significantly lower than that in low-value group[（75.15 ± 12.41） mm Hg vs.（86.36 ± 9.22） mm Hg]（P=0.016）.Conclusions PESI can effectively predict short-term prognosis of non high-risk APTE patients treated with sequential anticoagulation.At least some of these patients might need treatment other than sequential anticoagulation.