【摘要】 目的探讨简化肺栓塞严重程度指数(simplified pulmonary embolism severity index,s PESI)联合红细胞分布宽度(RDW)、中性粒细胞与淋巴细胞比值(NLR)对急性非高危肺栓塞患者预后的预测价值。方法收集山东省立医院自2017年1月至2019年12月确诊的急性非高危肺栓塞患者136例,并追踪随访6个月,根据结局分为存活组和死亡组。收集两组患者的一般临床资料和实验室检查资料、s PESI,进行组间比较。采用多因素Logistic回归分析确定急性非高危肺栓塞患者6个月全因死亡的预测因子,绘制受试者工作特征(ROC)曲线评价各预测因子的预测价值,并追踪随访6个月。结果入选136例患者,存活组124例,死亡组12例,两组年龄、恶性肿瘤、脉搏、NLR、单核细胞与淋巴细胞比值(MLR)、RDW、s PESI差异有统计学意义(P <0.05)。多因素Logistic回归分析显示,s PESI、RDW、NLR是急性非高危肺栓塞患者6个月内全因死亡的独立预测因子(s PESI:OR 5.675、95%CI 1.447~22.256,RDW:OR 1.569、95%CI 1.147~2.146,NLR:OR 1.511,95%CI 1.025~2.229)。ROC曲线分析显示,s PESI的曲线下面积(AUC)为0.826(95%CI 0.697~0.954),敏感度为83.33%,特异度为81.45%; RDW的AUC为0.767(95%CI0.627~0.908),敏感度为91.67%,特异度为59.68%; NLR的AUC为0.820 (95%CI 0.708~0.932),敏感度为83.33%,特异度为78.23%;三者联合的AUC为0.940(95%CI 0.895~0.984),敏感度为100.00%,特异度为78.23%。结论 s PESI联合RDW、NLR对急性非高危肺栓塞患者预后具有较高的预测价值。更多还原

【Abstract】 Objective To evaluate the prognostic value of simplified pulmonary embolism severity index( s PESI) combined with red cell distribution width( RDW) and neutrophil to lymphocyte ratio( NLR) in the patients with acute non-high-risk pulmonary embolism. Methods Patients with acute non-high-risk pulmonary embolism diagnosed in Shandong Provincial Hospital from January2017 to December 2019 were admitted,followed up for 6 months. Then the patients were divided into survival group and death group according to the outcome. The general clinical data,laboratory data and s PESI of the two groups were collected for inter-group comparison. Multivariate Logistic regression analysis was used to determine the predictors of 6-month all-cause mortality in the patients with acute non-high-risk pulmonary embolism,and the receiver operating characteristic( ROC) curve was drawn to evaluate the predictive value of each predictor. Results A total of 136 patients were enrolled,124 patients in the survival group,12 patients in the death group. There were significant differences in age,malignant tumor history,pulse rate,NLR,monocyte to lymphocyte ratio( MLR),RDW and s PESI between the two groups( P < 0. 05). The multivariate Logistic regression analysis found that s PESI,RDW and NLR were independent predictors of all-cause mortality within 6 months in the patients with acute non-high-risk pulmonary embolism( s PESI: OR 5. 675,95% CI 1. 447-22. 256,RDW: OR1. 569,95% CI 1. 147-2. 146,NLR: OR 1. 511,95% CI 1. 025-2. 229). Receiver operating characteristic( ROC) curve analysis showed that the area under the curve( AUC) of s PESI was 0. 826( 95% CI 0. 697-0. 954),the sensitivity was 83. 33%,and the specificity was 81. 45%. The AUC of RDW was 0. 767( 95% CI 0. 627-0. 908),the sensitivity was 91. 67%,and the specificity was59. 68%. The AUC of NLR was 0. 820( 95% CI 0. 708-0. 932),the sensitivity was 83. 33%,and the specificity was 78. 23%. The AUC of the combined three factors was 0. 940( 95% CI 0. 895-0. 984),the sensitivity was 100. 00%,and the specificity was 78. 23%. Conclusions s PESI combined with RDW and NLR has a high predictive value for the prognosis of the patients with acute non-high-risk pulmonary embolism.更多还原