肾功能生化指标对急性肺栓塞患者预后的评估价值

Prognostic value of renal function biochemical indexes in patients with acute pulmonary embolism

目的探讨肾功能生化指标预测急性肺栓塞患者短期预后不良的价值。方法回顾性分析2014年1月至2021年12月山西医科大学第一附属医院首次确诊的228例APE患者的临床资料,随访3个月,统计短期预后不良发生情况,对比预后不良组和预后良好组的各项肾功能生化指标水平,采用多因素Logistic回归分析影响APE患者不良预后的危险因素,应用受试者工作特征(ROC)曲线分析其对APE患者预后不良的预测效能。结果本研究中APE患者预后不良的发生率为36.40%(83/228);预后不良组血清BUN、UA、CysC均高于预后良好组(P均<0.05),预后不良组血清CrCl、钙离子、钠离子均低于预后良好组(P均<0.05)。多因素分析结果显示高水平BUN、UA是急性肺栓塞预后不良的危险因素,高水平CrCl、钙离子是急性肺栓塞预后不良的保护因素(P<0.05);绘制ROC曲线,结果显示,当血清CrCl、BUN、UA及钙离子的截断值分别取74.370mL/min、5.135mmol/L、325.500μmol/L、2.105mmol/L时,可获得APE预后不良风险最佳预测价值,AUC分别为0.870、0.923、0.867、0.655,联合检测的AUC为0.970。结论血清CrCl、BUN、UA及钙离子与急性肺栓塞患者预后密切相关,联合预测急性肺栓塞患者短期预后不良的预测效能更高。

Objective To explore the value of renal biochemical indexes in predicting the short-term prognosis of patients with acute pulmonary embolism(APE).Methods The clinical data of 228 patients with APE diagnosed for the first time in the First Affiliated Hospital of Shanxi Medical University from January 2014 to December 2021 were retrospectively analyzed.The patients were followed up for 3 months,and the short-termadverse prognosis was counted.The renal function biochemical indexes of the poor prognosis group and the good prognosis group were compared.Multivariate Logistic regression was used to analyze the risk factors affecting the poor prognosis of APE patients,and the receiver operating characteristic(ROC)curve was used to analyze its predictive efficacy for the poor prognosis of APE patients.Results In this study,the incidence of poor prognosis in APE patients was 36.40%(83/228).Serum BUN,UA,and cystatin C(CysC)in the poor prognosis group were higher than those in the good prognosis group(all P<0.05),whereas serum CrCl,calcium ion,and sodium ions in the poor prognosis group were lower than those in good prognosis group(all P<0.05).Multifactor analysis showed that high levels of BUN and UA were risk factors for poor prognosis of acute pulmonary embolism,and high levels of CrCl and calcium ions were protective factors for poor prognosis of acute pulmonary embolism(P<0.05).ROC curve results showed that when the cut-off values of serum CrCl,BUN,UA,and calcium ions were 74.370mL/min,5.135mmol/L,325.500μmol/L,and 2.105mmol/l respectively,the best predictive value of poor prognosis risk of APE could be obtained.The AUC values were 0.870,0.923,0.867,and 0.655,respectively,and the AUC value of combined detection was 0.970.Conclusion Serum CrCl,BUN,UA,and calcium ions are closely related to the prognosis of patients with acute pulmonary embolism,and the combined prediction of short-term poor prognosis of patients with acute pulmonary embolism is more effective.