红细胞计数和纤维蛋白原联合血小板计数预测急性肺栓塞危险分层的价值

The predictive value of red blood cell count, fibrinogen combined with platelet count for risk stratification of acute pulmonary embolism

目的研究红细胞计数(RBC)和纤维蛋白原(FBG)联合血小板计数(PLT)预测急性肺栓塞(PE)危险分层的价值。方法回顾性收集北京朝阳医院2013年1月至2019年10月间入院确诊为急性PE的患者,按照危险分层标准,患者分为高/中危组和低危组,对两组患者的人口学特征,既往病史,RBC和PLT各项参数指标以及FBG进行比较及统计学分析,观察两组间有差异无统计学意义。结果本研究共计人组患者696例,其中高/中危组193例,低危组503例,经研究发现RBC和红细胞压积(HCT)在高/中危组高于低危组,FBG和PLT在高/中危组低于低危组,差异有统计学意义(P<0.05),而年龄、性别、既往病史以及血红蛋白(HGB),HCT,平均红细胞体积(MCV),平均红细胞血红蛋白(MCHC),红细胞分布宽度(RDW),血小板分布宽度(PDW),血小板平均体积(MPV),大血小板比率(P-LCR)在两组间差异无统计学意义。Logistic回归分析显示RBC、PLT和FBG是急性肺栓塞危险分层的独立影响因素,RBC与危险分层呈正相关,PLT和FBG呈负相关。RBC、PLT和FBG预测危险分层准确性的ROC曲线下面积(AUC)分别为0.552(95%CI:0.514~0.589),0.591(95%CI:0.554~0.628)和0.565(95%CI:0.527~0.602)。三项指标联合的AUC为0.620(95%C7:0.0.582~0.656),最佳临界值下各项指标对应的数值分别为4.57×10^12/L^-1;1,182×10^9/L^-1和322.8 mg/dL,三者联合预测危险分层的敏感性为51.3%,特异性为78%。结论RBC和FBG联合PLT对急性PE危险分层具有一定的临床预测价值。

Objective To explore the predictive value of red blood cell count(RBC),fibrinogen(FBG)combined with platelet count(PLT)for risk stratification of acute pulmonary embolism(PE).Methods Patients admitted to Beijing Chaoyang Hospital from January 2013 to October 2019 and diagnosed with acute PE were retrospectively collected.According to the risk stratification criteria for PES the patients were divided into the high/medium risk group and low risk group.The demographic characteristics,previous medical history,parameters of RBC and PLT,and FBG of the two groups were compared.Results Totally 696 patients were selected in the study,of them,193 patients were in the high/medium risk group and 503 in the low risk group.RBC and hematocrit(HCT)in the high/medium risk group were significantly higher than those in the low risk group,but FBG and PLT in the high/medium risk group were significantly lower than those in the low risk group(all P<0.05).There was no significant difference in age,gender,previous medical history,hemoglobin(HGB),HCT,mean corpuscular volume(MCV),mean corpuscular hemogloin(MCHC),red blood cell distribution width(RDW),platelet distribution width(PDW),mean platelet volume(MPV),and platelet large cell rate(P-LCR)between the two groups.Logistic regression analysis showed that RBC,PLT and FBG were independent influencing factors for risk stratification of acute PE.RBC was positively correlated with risk stratification,while PLT and FBG were negatively correlated.The area under the ROC curve(AUC)of RBC,PLT and FBG were 0.552(95%Cl:0.514-0.589),0.591(95%Cl:0.554-0.628),and 0.565(95%Cl:0.527-0.602),with the cut-off value of 4.57×10^12/L^-1;1,182×10^9/L^-1 and 322.8 mg/dL,respectively.Conclusions RBC,FBG combined with PLT have clinical predictive value for risk stratification of acute PE.