肺动脉栓塞的危险分级与多项指标的临床相关性应用

Clinical application of pulmonary embolism risk stratification with multiple markers

目的评估血浆D二聚体(DD)等血凝标志物、心肌损伤标志物、血气分析等在肺动脉栓塞(PE)危险分层诊断及预后的临床价值。方法 201例PE患者其中高危组52例,中危组88例,低危组61例,治疗组67例,正常对照组38例。分析多项指标的表达水平。结果 PE者高危组、中危组和低危组的DD、纤维蛋白原(Fib)、N末端脑钠肽(NT-pro BNP)水平、凝血酶原时间(PT)、氧分压(PO_2)与治疗组和或正常对照组比较差异具有统计学意义(P<0.05),而除低危组外,高危组与中危组的肌钙蛋白I(cTnⅠ)、肌酸激酶同工酶(CK-MB)、国际标准化比值(INR)、凝血酶原活动度(PTA)和呼吸指数(RI)比较差异具有统计学意义(P<0.05),二氧化碳分压(PCO_2)仅中危组差异具有统计学意义(P<0.05),但肌酸激酶(CK)和血氧饱和度(SpO_2)差异无统计学意义(P>0.05)。结论联合多项指标不仅可作为肺动脉栓塞的危险分层鉴别诊断指标,其浓度的变化有助于判断预后及指导治疗。

Objective To evaluate the clinical value of coagulation markers（D-dimer,etc.）,myocardial injury markers and blood gas analysis in the risk stratification of PE and prognosis of pulmonary embolism（PE） Methods Totally 201 patients with PE were divided into high-risk group（n=52）,intermediate-risk group（n=88）,low-risk group（n=61）,treatment group（n=67）and 38 normal controls and the level of multiple markers was analyzed. Results DD,Fib,NT-proBNP,PT and PO2of PE patients（high-,intermediate- and low-risk group）were statistically different from those of treatment group and normal controls（P〈0.05）;cTnⅠ,CK-MB, INR,PTA and RI of high- and intermediate-risk group were statistically different（P 〈 0.05）;but CK and SpO2 were not（P〉0.05）.Conclusions Multiple markers can be used as a clue to screen high-,intermediate-and low-risk PE.It also could be used to distinguish the prognosis of PE.