D-二聚体与排除肺栓塞的AECOPD患者预后的相关性研究

Study on D-dimer and prognosis of AECOPD excluding pulmonary embolism

目的探讨血浆D-二聚体水平对排除肺栓塞（PE）的慢性阻塞性肺疾病急性加重期（AECOPD）患者预后的评估意义。方法收集2007-2011年南通大学附属医院呼吸科及急诊内科普通病区收治的AECOPD患者,35例血浆D-二聚体阳性且CT血管造影排除PE及下肢深静脉血栓（DVT）患者作为试验组,35例血浆D-二聚体阴性AECOPD患者作为对照组,比较两组患者首次住院的住院时间、GOLD分级、病死率及4年内再住院次数、ICU入住次数、气管插管次数、再住院及院外死亡的差异。应用ROC曲线评价D-二聚体的近期和远期预后评估能力。随访终点应用t检验对死亡组、存活组的D-二聚体水平进行分析。结果试验组与对照组D-二聚体水平、住院时间、首次住院死亡人数、再住院次数、ICU入住次数、插管次数、再住院及院外病死率、总病死率的差异有统计学意义（P〈0.05）;两组间年龄、性别、GOLD分级比较差异无统计学意义（P〉0.05）。D-二聚体大于1 165μg/L预测首次住院期间病死率的灵敏度为87.5%,特异度为80.6%。D-二聚体大于865μg/L预测再住院及院外病死率的灵敏度为78.9%,特异度为74.5%。两组患者随访期间生存曲线图显示随访期间,两组患者生存时间及生存率差异均有统计学意义。死亡组D-二聚体水平明显高于存活组,差异有统计学意义（P〈0.05）。结论 D-二聚体水平是影响AECOPD近期及远期预后的独立危险因素。

Objective To investigate the evaluation significance of plasma D-dimer level for the prognosis in acute exacerbation of chronic obstructive pulmonary disease（AECOPD）excluding pulmonary embolism（PE）.Methods The patients with AECOPD were collected from the respiration department and emergency internal medicine department of the Affiliated Hospital of Nantong University during 2007-2011.Thirty-five AECOPD cases of D-dimer positive and excluding PE and lower extremity deep venous thrombus（DVT）by CT angiography served as the experimental group and 35 cases of D-dimer negative as the control group.The differences in the first time hospitalization duration,GOLD grade,mortality rate,re-hospitalization times within 4years,times of admission to ICU,times of intracheal intubation,rehospitalization and outside-hospital mortality rate were compared between the two groups.The receiver operating characteristic（ROC）curve was applied to evaluate the short-term and long-term prognostic capacity of D-dimer.The t test at the follow up end point was used to analyze the D-dimer level in the death group and the survival group.Results The D-dimer level,length of hospital stay,death number of first time hospitalization,times of re-hospitalization,times of admission to ICU,times of intubation,re-hospitalization and outside-hospitalization mortality rate and total mortality rate had statistical differences between the experimental group and the control group（P〈0.05）;but the differences in the age,gender and GOLD grade between the two groups had no statistical significance（P〈0.05）.The sensitivity of D-dimer〉1 165μg/L for predicting the death number of the first time hospitalization was 87.5%,and the specificity was 80.6%.The sensitivity of D-dimer〉865μg/L for predicting the mortality rate of re-hospitalization and outerside-hospital was 78.9%,and the specificity was 74.5%.The survival curve graph during the follow up period in the two groups revealed that the survival time and survival rate had statistical difference between the two groups.The D-dimer level in the death group was significantly higher than that in the survival group with statistical difference（P〈0.05）.Conclusion The D-dimer level is an independent risk factor affecting the short-term and longterm prognosis of AECOPD.