探讨高敏肌钙蛋白I用于评估急性肺栓塞患者预后的价值

Predictive Value of the High-Sensitivity Cardiac Troponin I in Patients with Acute Pulmonary Embolism

目的探讨高敏肌钙蛋白I(hs-c Tn I)阴性结果在筛选急性肺栓塞(APE)低危患者中的预测价值。方法回顾性分析272例在北京安贞医院住院的APE患者的临床资料以及30 d内不良事件发生情况。根据hs-c Tn I测定结果,将患者分为高hs-c Tn I组和低hs-c Tn I组。应用简化肺栓塞严重指数(s PESI)进行临床风险评估。不良事件定义为30 d内死亡、出现严重并发症、需要溶栓治疗或机械通气。绘制不同hs-c Tn I水平组患者的生存曲线。应用多因素Logistic逐步回归模型进行统计分析。结果高hs-c Tn I组30 d内死亡、急性肾功能衰竭、出血及需要溶栓治疗的比例分别为6.1%、14.6%、13.4%和7.9%,均显著高于低hs-c Tn I组(P值分别为0.009、<0.001、0.018和0.003)。在s PESI评分≥1组中,低hs-c Tn I患者不良事件的发生率明显低于高hs-c Tn I患者(P=0.005)。s PESI预测APE患者不良预后的2值为11.25(P=0.001),加入hs-c Tn I后2值升高至26.25(P<0.001)。结论 hs-c Tn I在评估APE短期预后时具有良好的阴性预测价值,且在s PESI基础上可显著增加对APE短期预后的预测能力。

Objective To evaluate the predictive value of the high-sensitivity cardiac troponin I （hs-cTnI） in patients with acute pulmonary embolism （APE）. Methods In a retrospective cohort study, 272 consecutive patients with APE were reviewed and the 30-days death and in-hospital adverse events were evaluated. The patients were classified according to hs-cTnI value into a high hs-cTnI group and a low hs- cTnI group. The simple pulmonary embolism severity index （sPESI） was used for clinical risk determination. The adverse event was defined as intravenous thrombolytic therapy, noninvasive ventilator support to maintain oxygen saturation 〉 90% and suffered with severe complications. The correlations of hs- cTnI with sPESI score, 30-days adverse events and mortality were analyzed. The Kaplan-Meier curves and the log-rank test were used to compare time-to-event survival. Stepwise multivariate logistic regression analysis models were used to determine the incremental prognostic value of sPESI score and hs-cTnI. Results The incidence of 30-day death （6. 1% ）, renal failure （ 14. 6% ）, bleeding （ 13.4% ） and thrombolytic therapy （7.9%） were higher in the high hs-cTnI group than those in the low hs-cTnI group （P values were 0. 009, 〈0. 001,0. 018 and 0. 003 ,respectively）. The patients with sPESI≥1 and low hs-cTnI had greater free adverse events survival （P = 0. 005 ）. hs-cTnI provided incremental predictive value for in-hospital adverse events, beyond the sPESI score （P 〈 0. 001 ）. Conclusion hs-cTnI has excellent negative predictive value of APE prognosis, especially when used combined with sPESI score.