中高危急性肺血栓栓塞症患者CTPA检查中Qanadli指数的预后意义

Prognostic significance of CT Qanadli index in patients with moderate to high risk of acute pulmonary thromboembolism

目的:探讨中高危急性肺血栓栓塞(APTE)患者肺动脉CT血管成像(CTPA)检查中Qanadli指数的预后意义。方法:回顾性搜集我院107例中高危APTE患者的病例资料。所有患者行CTPA检查并计算Qanadli指数,分析Qanadli指数与患者临床危险分层、APTE相关不良事件和短期预后的关系。结果:高危组、中高危组和中低危组的Qanadli指数依次降低,组间差异均有统计学意义(P<0.05)。高Qanadli指数组中休克、机械通气、心肺复苏和死亡的发生率均高于低Qanadli指数组(P<0.05)。Qanadli指数预测患者死亡的ROC曲线下面积(AUC)为0.934±0.048,Qanadli指数为50.5%时,预测敏感度和特异度分别为88.9%和92.9%。Qanadli指数预测患者预后不良的AUC为0.977±0.018,Qanadli指数为45.5%时,预测敏感度和特异度分别为90.5%和98.8%。性别、年龄、体重指数、手术史、吸烟、高血压、糖尿病、冠心病、慢性肾病和D-二聚体水平等临床指标的不同分组间预后不良的发生率比较,差异均无统计学意义(P>0.05);恶性肿瘤史及不同水平B型脑钠肽、心肌肌钙蛋白T和Qanadli指数的分组间患者的预后不良发生率比较,差异均有统计学意义(P<0.05)。Logistic回归分析显示,B型脑钠肽、心肌肌钙蛋白T和Qanadli指数是患者预后不良的独立危险因素(P<0.05)。结论:CTPA检查中Qanadli指数是判断APTE患者短期预后的可靠指标,值得临床推广应用。

Objective:To investigate the prognostic significance of CT Qanadli index in patients with moderate to high risk acute pulmonary thromboembolism(APTE).Methods:A retrospective review of 107 patients with moderate to high risk APTE admitted to our hospital was performed.All patients underwent pulmonary CT angiography and the Qanadli index was calculated.The correlation between the Qanadli index and clinical risk stratification,APTE-related adverse events,and short-term prognosis was analyzed.Results:Compared with the high-risk group,the Qanadli index was lower in the middle-high-risk group and the middle-lower-risk group(P<0.05).Compared with the middle-high-risk group,the Qanadli index was lower in the middle-lower-risk group(P<0.05).The incidence of shock,mechanical ventilation cardiopulmonary resuscitation and death were higher in the high-Qanadli index group than that in the low-Qanadli index group(P<0.05).The area under the ROC curve of the Qanadli index predicting the patient's death was 0.934±0.048.When the value of the Qanadli index was 50.5%,the sensitivity and specificity were 88.9%and 92.9%,respectively.The area under the ROC curve of the Qanadli index predicting poor prognosis was 0.977±0.018.When the value of the Qanadli index was 45.5%,the sensitivity and specificity were 90.5%and 98.8%,respectively.There was no significant difference in the poor prognosis rate between different groups of gender,age,body mass index,surgical history,smoking,hypertension,diabetes,coronary heart disease,chronic kidney disease and D-dimer(P>0.05).There was significant difference in the poor prognosis rate between difference groups of malignant tumor,B-type brain natriuretic peptide,cardiac troponin T and Qanadli index(P<0.05).Logistic regression analysis showed that type B brain natriuretic peptide,cardiac troponin T and Qanadli index were independent risk factors for poor prognosis(P<0.05).Conclusion:The CT Qanadli index is a reliable indicator to judge the short-term prognosis of patients with APTE,which is worthy of clinical application.