高敏肌钙蛋白Ⅰ联合GRACE评分评估急性肺栓塞患者预后的价值

Prognostic evaluation of hs-cTnⅠ combined with GRACE score in patients with acute pulmonary embolism

目的探讨高敏肌钙蛋白Ⅰ(hs-cTnⅠ)联合全球急性冠状动脉事件注册(GRACE)评分评估急性肺栓塞患者预后的价值。方法选取急性肺栓塞患者178例,采用急性冠脉综合征的GRACE评分标准将患者分为低危组37例、中危组56例和高危组85例,根据hs-cTnⅠ测定结果将患者分为高hs-cTnⅠ组(hs-cTnⅠ>0.01 ng/mL)114例和低hs-cTnⅠ组(hs-cTnⅠ≤0.01 ng/mL)64例,比较各组30 d死亡情况和不良事件发生情况。根据30 d临床结局将急性肺栓塞患者分为死亡组38例和存活组140例,单因素及多元Logistic回归分析影响急性肺栓塞患者预后的危险因素,Spearman等级相关系数分析各危险因素的相关性。结果高hs-cTnⅠ组30 d死亡、咯血、呼吸衰竭及溶栓治疗的发生率均明显高于低hs-cTnⅠ组(P均<0.05),高危组30 d死亡、咯血、呼吸衰竭及溶栓治疗的发生率均明显高于低危组(P均<0.05)。单因素筛选出有统计学意义的因素进行多元Logistic回归分析显示,hs-cTnⅠ水平高、GRACE评分高是急性肺栓塞患者死亡的独立危险因素,其OR及95%CI分别为1.726[1.273,2.346]、2.457[1.846,3.272]。ROC曲线显示,hs-cTnⅠ、GRACE评分及二者联合预测急性肺栓塞患者30 d病死率的AUC及95%CI分别为0.754[0.672,0.847]、0.772[0.686,0.869]、0.832[0.749,0.925],二者联合的AUC明显大于hs-cTnⅠ及GRACE评分(P均<0.05),其灵敏度和特异度为76.8%,85.2%。相关性分析显示,GRACE评分与hs-cTnⅠ水平呈明显正相关(r=0.673,P<0.05)。结论 hs-cTnⅠ水平高、GRACE评分高是急性肺栓塞患者死亡的独立危险因素,二者联合评估急性肺栓塞患者预后价值更高。

Objective It is to evaluate the prognostic value of high sensitive cardiac troponin I（hs-cTnl） combined with global acute coronary events（GRACE）score in patients with acute pulmonary embolism （APE）. Methods 178 cases patients with APE were divided into 37 eases of low risk group,56 cases of medium risk group and 85 cases of high-risk group of and 150 cases according to GRACE standard for evaluation of acute coronary syndrome, and were divided into 114 cases of high hs-cTnI group （hs-cTnI 〉 0.01 ng/mL） and 64 cases of low hs-cTnI group （hs-cTnI ≤0.01 ng/mL） according to hs-cTnI detection results,the 30 days mortality rates and occurrences of adverse events in every group were compared. According to 30 days clinical outcome all the patients were divided into 38 cases of death group and 140 cases of survival group. The risk factors of prognosis of APE were analyzed by single and multivariate Logistic regression analysis, the correlation among each risk factor was analyzed by Spearman rank correlation coefficient analysis. Results The incidence of 30 days of death, hemoptysis, respiratory failure and thrombolytic therapy in high hs-cTnI group and high risk group were respectively significantly higher than those in low hs-cTnI group and low risk group（P 〈 0.05）. Multivariate Logistic regression analysis showed that high levels of hs-cTnI and GRACE scores were independent risk factors of death in patients with APE, and its the OR value and 95%CI were 1.726[1.273 to 2. 346],2.457[1.846 to 3. 272]. The ROC curve showed that the AUC and 95% CI of hs-cTnI, GRACE score and their combination for prediction 30 days mortality in patients with APE were 0. 754 [ 0. 672 to 0. 847], 0. 772 [ 0. 686 to 0. 869 ], 0. 832 [ 0. 749 to 0. 925 ], the AUC of their combination were significantly higher than hs-cTnI and GRACE score （ P 〈 0.05 ） , and its sensitivity and specificity were 76.8% , 85.2%. Correlation analysis showed that GRACE score was positively correlated with bs-cTnI level （ r = 0. 673, P 〈 0.05 ）. Conclusion High level of hs-cTnI,high GRACE score are independent risk factors for death in patients with APE, the combined examination is more valuable than the single application in the prognosis of patients with APE.