摘要
目的探索凝血指标抗凝血酶Ⅲ(ATⅢ)在急性肺动脉血栓栓塞症(PTE)中的临床应用价值。方法采用回顾性研究方法,纳入2012年5月至2019年6月福建省立医院收住的204例已确诊的PTE患者,研究资料包括患者基本情况、基础疾病及入院24 h内实验室检查、评分系统,分析ATⅢ与PTE院内死亡及不良事件之间的关系,并进一步探究ATⅢ优化危险分层的价值。结果 ATⅢ水平预测PTE患者院内死亡率的受试者工作特征曲线下面积(AUC)为0.719,其中截断值为77.7%(敏感性64.71%,特异性80.21%)。根据截断值水平分为ATⅢ≤77.7%组(n=48)及ATⅢ>77.7%组(n=156),慢性心力衰竭、白细胞计数、血小板计数、谷丙转氨酶、白蛋白、肌钙蛋白I组间差异有统计学意义(P<0.05)。据院内死亡情况分为死亡组(n=17)与存活组(n=187),比较白细胞计数、ATⅢ、D-二聚体、谷丙转氨酶、白蛋白、肾小球滤过率、APACHEⅡ评分组间差异有统计学意义(P<0.05)。Logistics回归分析发现ATⅢ≤77.7%、白细胞计数为院内死亡的独立危险因素。运用受试者工作特征曲线分别对危险分层及危险分层联合ATⅢ进行院内死亡预测,AUC分别为0.705、0.813,差异有统计学意义(P<0.05)。进一步采用列线图展示危险分层联合ATⅢ新评分模型。结论 ATⅢ≤77.7%是院内死亡的独立危险因素,并有利于优化危险分层,其机制可能与血栓形成、右心功能障碍及炎症反应等有关。
Objective To explore the clinical application value of antithrombin Ⅲ(ATⅢ) in pulmonary thromboembolism(PTE). Methods A retrospective study included 204 patients with confirmed PTE who were admitted to Fujian Provincial Hospital from May 2012 to June 2019. The clinical data of the study included basic conditions,morbilities, laboratory examinations and scoring system within 24 hours after admission. The relationship between ATⅢand PTE in-hospital death was analyzed, and the value of ATⅢ to optimize risk stratification was explored. Results For ATⅢ, the area under receiver operating characteristic curve(AUC) of predicting in-hospital mortality was 0.719, with a cut-off value of 77.7%(sensitivity 64.71%, specificity 80.21%). The patients were divided into ATⅢ≤77.7% group(n=48)and ATⅢ>77.7% group(n=156) according to the cut-off value, and significant statistically differences were found in chronic heart failure, white blood cells count, platelets count, alanine aminotransferase(ALT), albumin and troponin I(P<0.05). According to the in-hospital mortality, patients were divided into a death group(n=17) and a survival group(n=187), and the differences in count of white blood cells, ATⅢ, D-dimer, ALT, albumin, estimated glomerular filtration rate and APACHEⅡ were statistically significant. Logistic regression analysis revealed that ATⅢ≤77.7% and white blood cells count were independent risk factors for in-hospital death. The risk stratification and the risk stratification combined ATⅢ to predict in-hospital death were evaluated by receiver operating characteristic curve, and the AUC was 0.705 and0.813, respectively(P<0.05). A new scoring model of risk stratification combined with ATⅢ was showed by nomogram.Conclusions ATⅢ≤77.7% is an independent risk factor for in-hospital death, and is beneficial to optimize risk stratification. The mechanism may be related to thrombosis, right ventricular dysfunction and inflammatory response.
作者
林晶
陈佳龙
吴淡森
石松菁
LIN Jing;CHEN Jialong;WU Dansen;SHI Songjing(Shengli Clinical Medical College of Fujian Medical University,Fuzhou,Fujian 350000,P.R.China;Department 2 of Intensive Care Medicine,Fujian Provincial Hospital,Fuzhou,Fujian 350000,P.R.China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2021年第3期189-194,共6页
Chinese Journal of Respiratory and Critical Care Medicine
基金
国家临床重点专科建设项目(2011-170)
福建省临床医学中心建设项目(2017-510)。
关键词
急性肺动脉血栓栓塞症
抗凝血酶Ⅲ
院内死亡
危险分层
Acute pulmonary thromboembolism
AntithrombinⅢ
In-hospital mortality
Risk stratification
