血浆CRP,D-D水平检测对急性血栓性肺栓塞危险分层的预测价值

Predictive Value in Risk Stratification of Plasma CRP and D-D Levels for Patients with Acute Pulmonary Embolism

目的探讨血浆C-反应蛋白(C reactive protein,CRP),D-二聚体(D-Dimer,D-D)水平对急性血栓性肺栓塞(acute pulmonary embolism,APE)危险分层的预测价值。方法选取2015年1月～2017年1月在西安市第九医院急诊科就诊的APE患者110例,根据2008年欧州心脏病学会(Uropean sosiety of cardiology,ESC)肺栓塞指南标准将APE患者分为低危组(n=36)、中危组(n=50)与高危组(n=24),采用免疫增强比浊法检测血浆CRP和D-D水平。结果随着危险分层的增加,左心室舒张末内径(left ventricular end diastolic diameter,LVEDD)、估测肺动脉收缩压(pulmonary artery systolic pressure estimation,PASPE)逐渐增高,血氧饱和度(oxyhemoglobin saturation,SaO_2)、动脉血氧分压(arterial partial pressure of oxygen,PaO_2)、左心室射血分数(left ventricular ejection fraction,LVEF)逐渐降低,组间比较差异均具有统计学意义(q=3.228～27.021,均P<0.05)。高危组血浆CRP和D-D水平及其异常率明显高于低中危组,中危组上述指标明显高于低危组,差异具有统计学意义(q=8.293～14.816,均P<0.05)。受试者工作特征(receiver operating characteristic,ROC)曲线显示,血浆CRP,D-D水平对APE危险分层的ROC曲线下面积(ROC AUC)值明显高于SaO_2,PaO_2,LVEF,LVEDD和PASPE,差异具有统计学意义(P<0.05)。结论血浆CRP和D-D水平对APE危险分层的预测价值满意,值得临床推广应用。

Objective To study the predictive value in risk stratification of plasma C reactive protein（CRP）,D-Dimer（D-D）levels for patients with acute pulmonary embolism（APE）.Methods 110 cases of patients with APE from emergency department of the Ninth Hospital of Xi’an City from January 2015 and January 2017 were selected.According to 2008 ESC pulmonary embolism guide standard,APE patients were divided into low-risk group（n=36）,moderate-risk group（n=50）and high-risk group（n=24）and plasma CRP,D-D levels were detected by immune enhanced turbidimetric method.ResultsWith the increase of risk stratification,left ventricular end diastolic diameter（LVEDD）and pulmonary artery systolic pressure estimation（PASPE）were gradually increased and oxyhemoglobin saturation（SaO2）,arterial partial pressure of oxygen（PaO2）and left ventricular ejection fraction（LVEF）were gradually decreased.Compared among groups,there were statistically differences（q=3.228～27.021,all P<0.05）.Plasma CRP and D-D level and abnormal rate of high-risk group were significantly higher than low-moderate risk groups,the above indicators of moderate-risk group were obviously higher than that of low-risk group,compared with significant difference（q=8.293～14.816,all P<0.05）.The receiver operating characteristic（ROC）curves showed that area under（ROC AUC）value in risk stratification of plasma CRP,D-D levels for patients with APE were significantly higher than SaO2,PaO2,LVEF,LVEDD and PASPE,compared with statistically significant differences（t=5.126～9.215,all P<0.05）.Conclusion The predictive value in risk stratification of plasma CRP and D-D levels for patients with acute pulmonary embolism was satisfying,and it is worthy of clinical popularization and application.