急性肺栓塞患者右心功能不全的相关预测指标研究

Predictors for Right Ventricular Dysfunction in Acute Pulmonary Embolism Patients

目的探讨急性肺栓塞(APE)患者右心功能不全(RVD)的相关预测指标。方法选取2013年7月—2016年9月于中国医科大学附属盛京医院确诊的符合纳入排除标准的APE患者127例,采用心脏超声评价入选患者是否有RVD,将入选患者分为RVD(+)组51例和RVD(-)组76例。收集入选患者的一般人口学资料、入院时心率、D-二聚体(D-dimer)水平、红细胞分布宽度(RDW)、脑钠肽前体及肌钙蛋白Ι情况,比较两组间差异。采用Logistic回归分析探讨APE合并RVD的影响因素;采用受试者工作特征(ROC)曲线评价指标对APE合并RVD的预测价值。结果 RVD(-)组与RVD(+)组入院时心率、D-dimer水平、肌钙蛋白Ι阳性率及脑钠肽前体阳性率比较,差异有统计学意义(P<0.05);性别、年龄、RDW比较,差异无统计学意义(P>0.05)。Logistic回归分析表明:入院时心率、肌钙蛋白I及脑钠肽前体是APE合并RVD的影响因素(P<0.05)。ROC曲线分析表明,入院时心率对于APE合并RVD预测的曲线下面积为0.726[95%CI(0.673,0.815),P<0.001],最佳截断值为89次/min,灵敏度为66.7%,特异度为75.0%。结论心率、肌钙蛋白Ι、脑钠肽前体对APE患者合并RVD存在影响。当APE患者入院时心率≥89次/min、肌钙蛋白Ι阳性、脑钠肽前体阳性时要高度怀疑患者存在RVD,需要严密监控。

Objective To investigate the predictors for right ventricular dysfunction（ RVD） in acute pulmonary embolism（ APE） patients. Methods We enrolled 127 patients who were diagnosed with APE in Shengjing Hospital of China Medical University from July 2013 to September 2016 and met the inclusion and exclusion criteria of this study. They were divided into RVD（ ＋） group（ n = 51） and RVD（-） group（ n = 76） based on the results of echocardiography（ ECHO）. We collected and compared the demographic characteristics,values for heart rate（ HR）,D-dimer,red blood cell distribution width（ RDW）,N-terminal B-type natriuretic peptide（ NT-pro-BNP） and cardiactroponin I（ c Tn I） measured on admission between the groups. We conducted Logistic regression analyses to investigate the factors associated with RVD and implemented ROC curve analyses to assess the value of these factors for the prediction of RVD in APE. Results The prevalence of HR,D-dimer,c Tn I and NT-pro-BNP abnormalities measured on admission differed significantly between the groups（ P 0. 05）,while the distribution of sex and age and value for RDW did not（ P 0. 05）. Logistic regression analyses found that HR,c Tn I and NT-pro-BNP were the associated factors for RVD in APE（ P 0. 05）. ROC curve analyses demonstrated that,the average AUC for HR for the prediction of RVD in APE was 0. 726 [95% CI（ 0. 673,0. 815）,P 0. 001]with an optimal cut-off value of 89 beats/min,a sensitivity of 66. 7% and a specificity of 75. 0%. Conclusion RVD is associated with HR,c Tn I and NT-pro-BNP in APE patients. Therefore, APE patients should be highly suspected with RVD and given close monitoring when they are identified with HR≥89 beats/min,c Tn I and NT-pro-BNP abnormalities on admission.