成人急性中高危肺血栓栓塞症的危险因素分析

Analysis of risk factors for acute moderate to high risk pulmonary thromboembolism in adults

目的通过收集成人急性中危肺血栓栓塞症(PTE)患者的临床资料,探讨成人急性中高危PTE的危险因素。方法回顾性分析湖南省人民医院2019年6月至2022年3月收治的100例成人急性中危PTE患者的临床资料,根据危险分层分为中低危组(34例)和中高危组(66例),收集所有患者的实验室数据及临床资料,采用二元logistic回归分析成人急性中高危PTE的独立危险因素;用受试者工作特征(ROC)曲线分析各独立危险因素对成人急性中高危PTE的预测能力。结果中低危PTE患者34例,男20例,女14例,年龄16~86(60.2±15.5)岁;中高危PTE患者66例,男36例,女30例,年龄34~82(63.6±9.6)岁;两组间的年龄、性别及危险因素差异无统计学意义(均P>0.05)。中高危组伴发疾病中肿瘤史比例明显高于中低危组,呼吸困难和气促症状比例明显高于中低危组(均P<0.05)。中高危患者的肌钙蛋白I、休克指数(SI)、N-末端B型脑钠肽前体(NT-proBNP)水平明显高于中低危患者,PaO_(2)、氧合指数水平明显低于中低危患者,差异具有统计学意义(均P<0.05)。超声心动图结果显示中高危PTE患者右心室内径直径(RV)、左心室内径直径(LV)、RV/LV、三尖瓣反流速度、肺动脉收缩压与中低危患者比较差异有统计学意义(均P<0.05)。CT肺动脉造影(CTPA)结果显示中高危患者RV、RV/LV、主肺动脉内径、血栓负荷均明显高于中低危患者,差异有统计学意义(均P<0.05)。多因素二元logistic回归分析发现SI、NT-proBNP、RV是预测中高危PTE的独立预测因子(均P<0.05)。SI、NT-proBNP、RV联合检测对中高危PTE具有较好的预测价值,其ROC曲线下面积(AUC)为0.984,灵敏度和特异度分别为90.32%和97.73%,阴性预测值为87.8%,阳性预测值为98.2%。结论SI、NT-proBNP、超声心动图RV和CTPA RV四个联合指标是成人急性中高危PTE的预测因子,为成人急性中危PTE的危险分层提供有力补充。

Objective To investigate the risk factors according to the clinical data of the adult patients with acute moderate to high risk pulmonary thromboembolism(PTE).Methods The clinical data of 100 adult patients with acute moderate-risk PTE in Hunan Provincial People′s Hospital from June 2019 to March 2022 were analyzed retrospectively.According to the risk stratification,they were divided into moderate to low risk group(34 cases)and moderate to high risk group(66 cases).The laboratory data and clinical data of all adult patients were collected,and the independent risk factors of acute moderate to high risk PTE in adults were analyzed by binary logistic regression;Receiver operating characteristic(ROC)curve was used to analyze the predictive ability of independent risk factors for acute moderate to high risk PTE.Results There were 34 patients with moderate to low risk PTE,20 males and 14 females,aged 16-86(60.2±15.5)years,66 patients with moderate to high risk PTE,36 males and 30 females,aged 34-82(63.6±9.6)years.There was no significant difference in age,gender and risk factors between the two groups(all P>0.05).The tumor history of concomitant diseases in moderate to high risk group was significantly higher than that in moderate to low risk group,and the symptoms of dyspnea and shortness of breath in moderate to high risk group were significantly higher than those in moderate to low risk group(all P>0.05).The levels of troponin I,shock index(SI)and N-terminal B-type brain natriuretic peptide precursor(NT-proBNP)in moderate to high risk group were significantly higher than those in moderate to low risk group,while the levels of PaO_(2)and oxygenation index in moderate to high risk group were significantly lower than those in moderate to low risk group,with statistical significant difference(all P<0.05).Echocardiographic results showed that there were significant differences in right ventricular inner diameter(RV),left ventricular inner diameter(LV),RV/LV,tricuspid regurgitation velocity and pulmonary systolic pressure between moderate to high risk PTE patients and moderate to low risk PTE patients(all P>0.05).CTPA results showed that RV,RV/LV,main pulmonary artery diameter and thrombus load in moderate to high risk PTE patients were significantly higher than those in moderate to low risk PTE patients(all P<0.05).Multivariate binary logistic regression analysis showed that SI,NT-proBNP and RV were independent predictors of moderate to high risk PTE(all P<0.05).The combined detection of SI,NT-proBNP and RV had a good predictive value for moderate to high risk PTE.The area under ROC curve(AUC)was 0.984,the sensitivity and specificity were 90.32%and 97.73%,respectively.The negative predictive value was 87.8%,and the positive predictive value was 98.2%.Conclusions SI,NT-proBNP,RV of echocardiography and RV of CTPA are the predictors of acute moderate to high risk PTE in adults,which provided a strong supplement for the risk stratification of acute moderate risk PTE in adults.