非高危急性肺栓塞相关短期不良事件危险因素分析

Analysis of risk factors for the prediction of short-term adverse event associated with acute non-high-risk pulmonary embolism

目的探究不同临床状况和实验室指标对急性非高危肺栓塞患者3个月内不良事件的预测价值。方法回顾性选择2016至2017年于首都医科大学附属北京安贞医院住院的非高危急性肺栓塞患者266例,根据3个月内是否发生不良事件分为对照组(n=256)和不良事件组(n=10),比较两组基本特征、实验室检查、心脏超声结果的差异,应用单因素、多因素COX生存分析探究影响急性肺栓塞患者3个月不良事件的危险因素。结果不良事件组的患有结缔组织病比例、患有活动性肿瘤比例、C反应蛋白、单核细胞/淋巴细胞数值比值(monocyte/lymphocyte ratio,MLR)、尿素水平显著高于对照组(均P<0.05),红细胞计数、血红蛋白水平显著低于对照组(均P<0.05)。单因素、多因素COX生存分析显示MLR(风险比14.59,95%可信区间1.48~143.69,P=0.02)、合并结缔组织病(风险比5.85,95%可信区间1.11~30.81,P=0.04)在不良事件组与对照组间差异仍保持显著统计学意义。结论患者入院时MLR可能与非高危急性肺栓塞患者3个月内死亡相关。

Objective To evaluate the prognostic value of several indexes of laboratory and ultrasonic cardiogram for adverse events in 3 months following the diagnosis of acute non-high-risk pulmonary embolism.Methods A total of 266 cases of acute non-high-risk pulmonary embolism patients diagnosed and treated in Beijing Anzhen Hospital during 2016 to 2017 were retrospectively analyzed.The patients were divided into a bad event group and a control group according to whether there was a bad event happened in 3 months following the diagnosis.The general data,indexes of laboratory and ultrasonic cardiogram were compared.Univariate and multivariate COX regression analysis were conducted to explore independent risk factors for 3 months’poor prognosis.Results The bad outcome group had a significantly higher value of the proportion of suffering from connective disease and active cancer,C-reaction protein,monocyte/lymphocyte ratio(MLR)and urea while a significantly lower level of red blood cell count and hemoglobin compared with the control group(all P<0.05).Univariate and multivariate COX regression analysis showed that both the MLR(hazard ratio 14.59,95%confidence interval 1.48-143.69,P=0.02)and suffering from connective disease(hazard ratio 5.85,95%confidence interval 1.11-30.81,P=0.04)remain significantly different between the bad events group and the control group.Conclusion MLR at the admission may be related to the 3 months death of acute non-high-risk pulmonary embolism.