动态观察血钠波动程度对于APE患者短期预后的预测研究

Correlation analysis between fluctuation of serum sodium and prognosis in patients with acute pulmonary embolism

目的探讨动态血清钠波动程度对急性肺栓塞(acute pulmonary emblism,APE)患者短期预测价值。方法连续性纳入30例APE患者,根据患者的28天死亡率分为存活组(n=19)和死亡组(n=11),动态观察治疗前、治疗后第3天和第7天血清钠水平改变,综合分析血清钠水平波动与患者28天死亡率的关系。结果存活组患者血钠水平逐渐升高,而死亡组患者血钠水平逐渐降低,差异有统计学意义(P<0.05)。存活组治疗后第7天血钠水平均高于死亡组(136.7±3.9 mmol/L vs.128.3±3.0 mmol/L,P<0.05)。△1(治疗后3天-治疗前)的AUC为0.722,cut-off为-3.9 mmol/L,敏感性为79.9%、特异性为74.4%。△2(治疗后第7天-第3天)的AUC为0.714,cut-off为-4.6 mmol/L,敏感性为81.2%,特异性为81.2%。△3(治疗后第7天-治疗前)的AUC为0.789,cut-off为-5.7mmol/L,敏感性为87.5%、特异性为84.8%。Qanadli栓塞指数的AUC为0.755,cut-off为35.1,敏感性为81.2%、特异性为86.9%。通过Spearman相关性分析发现△1(r=-0.392,P<0.05)、△2(r=-0.377,P<0.05)和△3(r=-0.573,P<0.05)血钠水平与APE患者28天死亡风险呈负相关。△3与Qanadli栓塞指数呈负相关(r=-0.421,P<0.05)。Logistic回归发现Qanadli栓塞指数(>35.1)(OR=1.20,95%CI 0.90-1.45,P<0.05)和△3(OR=1.58,95%CI 0.84-2.25,P<0.05)为APE患者28天死亡事件的独立危险因素。结论动态观察血清钠水平波动有助于APE患者临床预后的预测评估。

Objective To evaluate the correlation between fluctuation of serum sodium and prognosis in patients with acute pulmonary embolism （ APE）. Methods 30 APE patients were enrolled in this study and divided into two group based on 28-day mortality ： the survival group （n = 19） and the death group （ n = 11） . The level of serum sodium were analyzed before and ,3,7 days after treatment. Results The level of serum sodium in the death group were gradually reduced while those were gradually increased in the survival group （ P 〈 0. 05 ）. The level of serum sodium in death group 7 days after treatment were lower than those in the survival group （136. 7 ± 3. 9 mmol/L vs. 128. 3 ± 3. 0 mmol/L,P 〈0. 05）. ROC analysis showed that AUC of △1, △2, △3 and Qanadli scores for prediction of APE prognosis were 0.722, 0.714, 0.789, and 0.755, respectively. Spearman correlation analysis showed △1,△2 and △3 were negatively related with 28-day mortality. Logistical regression analysis showed that Qanadli scores （ OR = 1.20, 95% CI 0 .9 0 - 1 .4 5 , P 〈0.05） and A3 （OR =1. 58, 95% CI 0.84 - 2.25 , P 〈0.05） were independently risk factors for APE prognosis forecast.