不同危险分层急性肺栓塞患者D-二聚体与纤维蛋白原比值、中性粒细胞与淋巴细胞比值、白蛋白的变化及其与预后的关系研究

Changes of D-dimer to Fibrinogen Ratio,Neutrophil to Lymphocyte Ratio and Albumin in Patients with Acute Pulmonary Embolism in Different Risk Stratification and Their Relationship Study with Prognosis

目的:探讨不同危险分层急性肺栓塞(APE)患者D-二聚体与纤维蛋白原比值(DFR)、中性粒细胞与淋巴细胞比值(NLR)、白蛋白(Alb)的变化及其与预后的关系。方法:选择2019年3月至2021年12月我院收治的APE患者154例作为APE组,根据《肺血栓栓塞症的诊断与治疗指南(2015)》分为低危组48例、中危组69例和高危组37例,另选择同期我院体检健康志愿者40例作为对照组,比较各组DFR、NLR、Alb水平。根据不同预后将APE患者分为存活组125例,死亡组29例,比较两组DFR、NLR、Alb水平。应用受试者工作特征(ROC)曲线分析DFR、NLR、Alb对APE预后的预测价值。结果:APE组DFR、NLR显著高于对照组,Alb水平显著低于对照组(P<0.05)。随着危险分层增加,APE患者DFR、NLR逐渐升高,Alb水平逐渐降低,不同危险分层APE患者DFR、NLR、Alb水平比较有统计学意义(P<0.05)。死亡组DFR、NLR显著高于存活组,Alb水平显著低于存活组(P<0.05)。ROC曲线分析显示,DFR、NLR、Alb对APE死亡预测具有较高的敏感度、特异度,其中DFR、NLR、Alb联合检测对APE死亡预测的曲线下面积(AUC)、敏感度、特异度最高。结论:APE患者DFR、NLR异常升高,Alb异常降低与APE危险分层增加及不良预后相关,DFR、NLR、Alb联合检测对APE患者预后不良的预测价值更高。

Objective:To investigate the changes of D-dimer to fibrinogen ratio(DFR),neutrophil to lymphocyte ratio(NLR),albumin(Alb)and their relationship with prognosis in patients with acute pulmonary embolism(APE)in different risk stratification.Methods:154 patients with APE who were admitted to our hospital from March 2019 to December 2021 were selected as APE group,according to the guidelines for the diagnosis and treatment of pulmonary thromboembolism(2015),they were divided into low-risk group with 48 cases,medium risk group with 69 cases and high-risk group with 37 cases.In addition,40 healthy volunteers in our hospital during the same period were selected as the control group,the DFR,NLR and Alb level in each group were compared.According to different prognosis,patients with APE were divided into survival group with 125 cases and death group with 29 cases.The DFR,NLR and Alb level were compared between the two groups.The predictive value of DFR,NLR and Alb on the prognosis of APE was analyzed by receiver operating characteristic(ROC)curve.Results:DFR and NLR in APE group were significantly higher than those in control group,and Alb level were significantly lower than that in control group(P<0.05).With the increase of risk stratification,the DFR,NLR and Alb level in patients with APE gradually increased,and the DFR,NLR and Alb level in patients with APE with different risk stratification were statistically significant(P<0.05).DFR and NLR in the death group were significantly higher than those in the survival group,and Alb level was significantly lower than that in the survival group(P<0.05).ROC curve analysis showed that DFR,NLR and Alb had high sensitivity and specificity for death prediction of APE,and the area under the curve(AUC),sensitivity and specificity of combined detection of DFR,NLR and Alb were the highest for death prediction of APE.Conclusion:The abnormal increase of DFR and NLR and the abnormal decrease of Alb in patients with APE are related to the increase of risk stratification and poor prognosis of APE.The combined detection of DFR,NLR and Alb has a higher predictive value for the poor prognosis of patients with APE.