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急性肺血栓栓塞症危险度分层的相关因素分析

Analysis of related factors in risk stratification of acute pulmonary thromboembolism

    摘要
  • 摘要:
    目的 探讨住院患者急性肺血栓栓塞症（acute pulmonary thromboembolism，APTE）危险度分层的相关因素。
    方法 选取2019年5月至2020年5月接受诊治的123例疑似为APTE的住院患者，分为栓塞组（n=93）和正常对照组（n=30）。将符合纳入标准的栓塞患者进行危险度分层和分组，中高危组60例，低危组33例。收集3组患者的临床资料，采用多因素logistic回归分析APTE的不同危险度与发病因素的相关性。
    结果 APTE中高危组、APTE低危组及正常对照组年龄，心房颤动、冠心病、下肢静脉血栓和脑血管病发生率，D-二聚体（D-Dimer，D-D）、纤维蛋白原（fibrinogen，FIB）、肺泡动脉氧分压差差异类有统计学意义（P < 0.05）。心脏彩超表现中，APTE患者以肺动脉压增高占比最高（62.37%）。年龄、冠心病、脑血管病、下肢静脉血栓、D-D、FIB、肺泡动脉氧分压差为APTE危险度分层独立影响因素（P < 0.05）。受试者工作特征曲线（ROC）显示，年龄影响APTE危险度分层的ROC曲线下面积（AUC）为0.621（95%CI 0.571~0.782）；D-D影响APTE危险度分层的AUC为0.646（95%CI 0.580~0.792）；FIB的AUC为0.887（95%CI 0.815~0.958）；肺泡动脉氧分压差的AUC为0.785（95%CI 0.686~0.885）。
    结论 年龄、冠心病、脑血管病、下肢静脉血栓、D-D、FIB、肺泡动脉氧分压差为APTE危险度分层的影响因素，对预测中/高危APTE价值较高。

     

    Abstract:
    Objective To investigate the correlation between risk stratification and risk factors in patients with acute pulmonary thromboembolism (APTE).
    Methods Totally, 123 patients with suspected pulmonary thromboembolism were selected from May 2019 to may 2020 and divided into embolism group (n=93) and normal control group (n=30). The embolism patients were divided into high/medium risk group (n=60) and low-risk group (n=33), their medical records were collected, and the correlation between APTE risk stratification and the risk factors was analyzed by the multivariate logistic regression model.
    Results There were statistical significant differences in the age, incidences of atrial fibrillation, coronary disease, lower extremity venous thrombosis, cerebrovascular disease, and the levels of D-D, FIB and A-aDO2 among three groups(P < 0.05). In APTE patients, elevated pulmonary artery pressure accounted for the highest proportion (51.22%). Age, coronary disease, cerebrovascular disease, lower extremity venous thrombosis, D-D, FIB, and A-aDO2 independently affected the risk stratification of APTE (P < 0.05). ROC curve results showed that AUC of age, D-D, FIB, and A-aDO2 for the diognosis of APTE was 0.621 (95% CI 0.571-0.782), 0.646 (95% CI 0.580-0.792), 0.887 (95% CI 0.815-0.958), and 0.785 (95% CI 0.686-0.885), respectively.
    Conclusions Age, coronary disease, cerebrovascular disease, lower extremity venous thrombosis, D-D, FIB, and A-aDO2 are the influencing factors of risk stratification of APTE. They have a higher value in predicting high/medium risk APTE.

     

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