简化肺栓塞严重度指数对老年肺栓塞预后判断价值的探讨

Predictive value of simplified pulmonary embolism severity index for pulmonary thromboembolism in the elderly

目的探讨简化肺栓塞严重度指数（sPESI）对老年肺栓塞（PTE）患者危险分层的价值。方法采取回顾性病例对照研究，将233例于2002年4月至2015年5月在北京积水潭医院确诊的PTE患者分为老年组（≥65岁，n=132）和非老年组（〈65岁，n=101），对老年和非老年PTE患者的合并症、临床特征、sPESI以及30d病死率进行分析。结果老年组年龄（76．32±6．77）岁，非老年组年龄（51．93±10．39）岁；30d病死率分别为22．73％和11．88％，两组差异具有统计学意义（P=0．033）。老年组合并心功能不全、心律失常、脑血管病、肾功能不全、高血压病、糖尿病及肺炎者较非老年组高，两组差异均有统计学意义（均P〈0．05）。14．39％的老年患者和13．86％的非老年患者合并肿瘤，差异无统计学意义（P=0．908），但两组合并肿瘤的构成不同，老年组以肺癌为主，而非老年组以骨肿瘤占多数。老年组动脉血氧分压低于非老年组[（59．39±11．00）vs（66．44±13．77）mmHg，P=0．002]，而肺动脉收缩压、脑钠肽及心肌肌钙蛋白I水平均高于非老年组，两组之间差异有统计学意义（P=0．000，P=0．003和P=O．041）。老年组和非老年组sPESI≥1者分别占73．48％和48．51％，两组差异有统计学意义（P=0．000）。老年组内死亡者与存活者比较，sPESI≥1的比例分别为90．00％和68．63％，两者差异有统计学意义（P=0．020）；死亡老年患者的sPESI均值也高于存活老年患者[（2．23±1．52）vs（1．18±1．11），P=0．001]。sPESI评估老年组和非老年组30d预后的ROC曲线下面积（AUC）分别为0．704（95％CI0．596-0．812）和0．723（95％CI0．551～0．896）。结论sPESI有助于老年PTE患者的危险分层。

Objective Simplified pulmonary embolism severity index （sPESI） is a practical validated tool aiming to stratify 30-day mortality risk in acute pulmonary thromboembolism （PTE）. However, guidelines for PTE risk stratification are not concerning on age. The aim of our study was to determine the prognostic value of sPESI in the elderly patients with PTE. Methods A retrospective case-control study was carried out on 233 consecutive patients with identified PTE admitted in our hospital from April 2002 to May 2015. They were divided into the elderly group （≥ 65 years old, n = 132） and the non-elderly group （〈 65 years old, n = 101）. Their complications, clinical features, sPESI score, and 30-day mortality were compared and analyzed. Results The patients of the elderly group were at age of （76.32 ± 6.77） years, and those of the non-elderly group were （51.93 ± 10.39） years. The former group had a 30-day mortality of 22.73%, and the latter of 11.88%, with significant difference between the two groups （P = 0.033）. The incidences of cardiac insufficiency, arrhythmia, cerebrovascular diseases, renal insufficiency, hypertension, diabetes and pneumonia were significantly higher in the elderly patients than in the non-elderly ones （all P 〈 0.05）. There was no significant difference in the incidence of malignant tumors between the elderly and non-elderly groups （14.39% vs 13.86%, P = 0.908）. But, the most common tumor was lung cancer in the elderly group, and bone tumor in the non-elderly group. The arterial partial pressure of oxygen was significantly lower in the elderly group than in the non-elderly group [（59.39 ± 11.00） vs （66.44 ± 13.77）mmHg, P = 0.002],but the pulmonary arterial pressure, serum levels of brain natriuretic peptide and cardiac troponin-I were obviously higher in the former than in the latter （P = 0.000, P = 0.003 and P = 0.041）. Significant difference was observed in the percentage of patients with sPESI score ≥1 between the two groups （73.48% vs 48.51%, P= 0.000）. In the elderly group, sPESI score ≥ 1 was found among 90.00% of the dead patients and 68.63% of the survival ones （P = 0.020）. The mean sPESI score was 2.23 ± 1.52 in the dead patients of the elderly group, significantly higher than those survived （1.18 ± 1.11, P= 0.001）. The area under the receiver-operating characteristic （ROC） curves was 0.704 [95% confidence interval （CI）： 0.596-0.812] for the elderly patients and 0.723 （95%CI： 0.551-0.896） for the non-elderly ones. Conclusion sPESI is helpful for risk stratification in the elderly patients with acute PTE.