血小板分布宽度在急性肺栓塞诊断及危险分层中的价值

The value of PDW in the diagnosis and risk stratification of acute pulmonary embolism

目的分析血小板分布宽度(PDW)在急性肺栓塞(APE)患者诊断及危险分层中的预测价值。方法回顾性分析2017年1月—2018年4月中国医科大学附属盛京医院呼吸与危重症医学科收治的APE患者(APE组)63例临床资料,按病情进一步分为低危亚组(33例)及中危亚组(30例),选取同时期健康体检者60例作为对照组。比较研究对象临床资料,分析PDW水平与APE分层相关性,及其在APE诊断与危险分层的应用价值。结果APE组PDW高于对照组(Z=2.113,P=0.035);低危亚组PDW低于中危亚组(Z=2.119,P=0.034),右室舒张末期内径、右室内径/左室内径、肺动脉内径均小于中危亚组(t/P=5.083/<0.001、5.022/<0.001、3.167/0.002);肺栓塞患者PDW与APE危险分层呈正相关(r=0.231,P=0.035);PDW诊断APE的曲线下面积(AUC)为0.612,最佳临界值为16.80%;应用于危险分层预测的AUC为0.656,最佳临界值为16.90%。结论血小板分布宽度在急性肺栓塞患者中升高,且与急性肺栓塞危险分层相关,中危患者高于低危患者,对急性肺栓塞诊断及危险分层具有一定应用价值。

Objective To analyze the predictive value of platelet distribution width(PDW)in the diagnosis and risk stratification of patients with acute pulmonary embolism(APE).Methods A retrospective analysis of the clinical data of 63 patients in the APE group admitted to the Department of Respiratory and Critical Care Medicine,Shengjing Hospital,China Medical University from January 2017 to April 2018,was further divided into low-risk subgroups(33 cases)and middle-risk subgroups according to their condition.In the critical subgroup(30 cases),60 cases of healthy physical examination patients at the same period were selected as the control group.Compare the clinical data of the study subjects,analyze the correlation between PDW level and APE stratification,and its application value in APE diagnosis and risk stratification.Results The PDW of the APE group was higher than that of the control group(Z=2.113,P=0.035);the PDW of the low-risk subgroup was lower than that of the middle-risk subgroup(Z=2.119,P=0.034),the end-diastolic diameter of the right ventricle,the right ventricular diameter/left ventricle The inner diameter and the inner diameter of the pulmonary artery were smaller than those in the middle-risk subgroup(t/P=5.083/<0.001,5.022/<0.001,3.167/0.002);PDW in patients with pulmonary embolism was positively correlated with APE risk stratification(r=0.231,P=0.035)The area under the curve(AUC)for PDW diagnosis of APE is 0.612,and the best cut-off value is 16.80%;the AUC used for risk stratification prediction is 0.656,and the best cut-off value is 16.90%.Conclusion Platelet distribution width increases in patients with acute pulmonary embolism,and is related to the risk stratification of acute pulmonary embolism.The intermediate-risk patients are higher than the low-risk patients,which has certain application value for the diagnosis and risk stratification of acute pulmonary embolism.