急性肺栓塞面积与D-二聚体、右心功能障碍和短期死亡风险相关性分析

Correlation analysis of acute pulmonary embolism area with D-dimer,right ventricular dysfunction,and short-term mortality risk

目的:探究急性肺栓塞(APE)患者的栓塞面积大小对D-二聚体水平、右心功能以及确诊后30 d内死亡风险的影响。方法:本研究连续收集天津医科大学第二医院和天津市胸科医院2018年9月—2021年6月因APE住院的患者377例。根据CT肺动脉造影检查结果:根据栓子部位将患者分为大面积APE组和局部APE组;使用N末端B型利钠肽前体(NT-proBNP)判定患者是否存在右心功能障碍;根据简化版PESI临床模型评估所有患者的30 d内死亡风险,进而分析比较不同栓塞面积所引起的D-二聚体、NT-proBNP等指标和短期死亡风险的差异。结果:D-二聚体每升高一个4分位数间距,出现大面积APE的可能性将升高1.94倍(OR=1.94,95%CI:1.56~2.42)。右心功能障碍与栓塞面积之间存在弱相关关系(Goodman系数=0.11,P=0.000),不同APE栓塞面积所导致的右心功能差异具有显著的统计学意义(χ^(2)=14.49,P=0.000)。大面积APE组与局部APE组之间确诊后30 d内死亡风险并未表现出显著统计学意义(χ^(2)=0.15,P=0.70)。结论:大面积APE的风险可能会随着D-二聚体水平升高而递增,其更易引起右心功能障碍。不同栓塞面积的APE所面临的短期死亡风险并无显著差异。

Objective:To investigate the impact of embolism area on D-dimer levels,right heart function,and the risk of death within 30 days after diagnosis in patients with acute pulmonary embolism(APE).Methods:This study collected 377 hospitalized patients with APE from the Second Hospital of Tianjin Medical University and the Thoracic Hospital of Tianjin from September 2018 to June 2021.According to the results of CT pulmonary angiography,all patients were divided into a large area APE group and a local APE group based on the location of the embolism.N-terminal B-type natriuretic peptide precursor(NT proBNP)was used to determine whether the patient has right heart dysfunction.The 30-day mortality risk of patients was evaluatedbased on a simplified version of the PESI clinical model,and then the differences in indicators such as D-dimer,NT proBNP,and short-term mortality risk caused by different embolism areas were analyzed and compared.Results:For every 4-quantile increase in D-dimer,the likelihood of large area APE increased by 1.94 times(OR=1.94,95%CI:1.56-2.42).There was a weak correlation between right heart dysfunction and embolic area(Goodman coefficient=0.11,P=0.000),and the difference in right heart function caused by different APE embolic areas was statistically significant(χ^(2)=14.49,P=0.000).There was no statistically significant risk of death within 30 days after diagnosis between the large area APE group and the local APE group(χ^(2)=0.15,P=0.70).Conclusion:The risk of large-scale APE may increase with the increase of D-dimer levels,which is more likely to cause right heart dysfunction.There is no significant difference in the short-term mortality risk faced by APE with different embolic areas.