红细胞分布宽度D-二聚体及下肢深静脉血栓联合检测在老年患者肺血栓栓塞症诊断中的价值研究

Diagnostic Value of the Combination of RDW,D-dimer,and Lower Extremity Deep Venous Thrombosis in Elderly Patients with Pulmonary Thromboembolism

目的分析红细胞分布宽度(red blood cell distribution width,RDW)、D-二聚体(D-dimer,D-D)及下肢深静脉血栓(lower extremity deep venous thrombosis,LEDVT)与老年患者肺血栓栓塞症(pulmonary thromboembolism,PTE)的关系,并探讨三者联合预测老年PTE的价值。方法回顾性分析2018年12月—2020年12月期间厦门大学附属中山医院收治的120例年龄≥65岁临床疑诊PTE患者的临床资料,按照CT肺动脉造影(computed tomographic pulmonary angiography,CTPA)结果分为非PTE组(CTPA阴性组)、PTE组(CTPA阳性组)。通过单因素和多因素分析法探讨RDW、D-D及LEDVT与老年PTE的相关性,并绘制预测PTE的受试者工作特征(receiver operating characteristic,ROC)曲线。结果老年PTE组与非PTE组RDW、D-D及LEDVT比较,差异有统计学意义(P<0.05);多因素非条件logistic回归分析显示,RDW、D-D及LEDVT均是老年患者发生PTE的危险因素;ROC曲线结果显示,RDW、D-D及LEDVT曲线下面积(area under the curve,AUC)分别为0.723、0.753、0.754,三者联合AUC为0.854(P<0.01)。结论老年患者RDW、D-D及LEDVT与PTE发生明显相关,三项指标联合有良好的诊断和预测价值,对早期识别老年PTE患者有一定的临床意义。

Objective To analyze the relationship between red blood cell distribution width(RDW),D-dimer(D-D)and lower extremity deep venous thrombosis(LEDVT)and pulmonary thromboembolism(PTE)in elderly patients with pulmonary thromboembolism(PTE),and to explore the value of the combination of the three indexes in predicting PTE in the elderly.Methods The clinical data of 120 patients aged≥65 years with clinically suspected PTE admitted to Zhongshan Hospital Affiliated to Xiamen University during December 2018 to December 2020 were retrospectively analyzed and were divided into non-PTE group(CTPA-negative group)and PTE group(CTPA-positive group)according to their CT pulmonary angiography(CTPA)results.The correlation of RDW,D-D and LEDVT with PTE in the elderly was explored by univariate and multivariate analyses,and ROC curves for predicting PTE were plotted.Results The RDW,D-D and LEDVT in the elderly PTE group were significantly different with the non-PTE group(P<0.05).The multivariate logistic regression analysis showed that RDW,D-D and LEDVT were all risk factors for the occurrence of PTE in the elderly patients.The ROC curve showed that the area under the curve(AUC)of RDW,D-D and LEDVT were 0.723,0.753 and 0.754,respectively,and the combined AUC of the three indexes was 0.854(P<0.01).Conclusion RDW,D-D and LEDVT in elderly patients are significantly associated with the occurrence of PTE,and the combination of the three indicators has good diagnostic and predictive value,which is of clinical significance for the early identification of PTE in elderly patients.