摘要目的 分析简化肺栓塞严重性指数(sPESI)及B型尿钠肽(BNP)、超敏肌钙蛋白Ⅰ(hs-TnⅠ)在肺栓塞短期及长期预后评价中的作用及联合检测的意义.方法 收集大连医科大学附属第一医院2010年1月至2012年9月连续162例肺栓塞患者资料,其中男68例,女94例,以院内死亡、休克、机械通气、心肺复苏为主要终点,以38个月内的死亡为次要终点,在全部人群及血流动力学稳定亚组中分析sPESI、BNP、hs-TnI等与主要及次要终点的联系,进行变量回归分析,筛选最佳指标,评价联合检测的价值.结果 162例患者主要终点多变量回归中,只有BNP、hs-TnⅠ、sPESI为独立预测因素,ROC曲线面积、OR值分别为0.87、8.16,0.91、6.09和0.78、14.07.血流稳定亚组的主要终点多变量回归中,仅BNP、sPESI是独立预测因素.次要终点的COX分析中,仅sPESI是独立危险因素.联合BNP、hs-TnⅠ后院内事件的阳性预测值提高(44.4％),阴性预测值未下降(97.8％),均阴性或单阳性患者中,没有主要终点发生于sPESI低危组.结论 sPESI能够反映肺栓塞的整体风险,在肺栓塞预后尤其是长期预后评价中有较高价值,可以被融合进肺栓塞的风险评价中.在肺栓塞短期预后评价中,BNP、hs-TnⅠ是最优秀指标.三者联合可以更全面地评估肺栓塞的短期及长期预后.

abstractsObjective To evaluate the value of simplified pulmonary embolism severity index (sPESI),brain natriuretic peptide (BNP) and high-sensitivity troponin Ⅰ (hs-TnⅠ) in predicting the short-term and long-term prognosis of patients with acute pulmonary embolism.Methods We collected the clinical data of 162 consecutive patients with acute pulmonary embolism in The First Affiliated Hospital of Dalian Medical University from January of 2010 to September of 2012.Hospital death,shock,mechanical ventilation and cardiopulmonary resuscitation were defined as the primary endpoints while death within 38 months as the secondary endpoint.The correlations between sPESI,BNP and hs-TnⅠ,and the primary and secondary endpoints in the overall cohort and hemodynamically stable subgroup were analyzed respectively.Results BNP,hs-TnⅠ and sPESI were independent predictors in multivariate regression of the primary endpoints in the overall cohort.The area under ROC curve and the risk odds ratio of them were 0.87,8.16 ;0.91,6.09 and 0.78,14.07 respectively.Only BNP and sPESI were independent predictors in multivariate regression of the primary endpoints in hemodynamically stable subgroup.Only sPESI was an independent risk factor in COX regression of the secondary endpoint.The combination of BNP and hs-TnⅠ further improved the positive predictive value (44.4％),while the negative predictive value was unaffected (97.8％).There was no adverse event in patients with low score of sPESI and single-positive or negative combination of BNP and hs-TnⅠ.Conclusion sPESI could reflect overall risk of pulmonary embolism.It had a high value in the evaluation of pulmonary embolism prognosis,especially for long-term prognosis.It should be integrated into the risk stratification strategy of pulmonary embolism.In the evaluation of short-term prognosis,BNP and hs-TnⅠ were the best indicators,and the combination of BNP,hs-TnⅠ and sPESI could further improve the prognostic value.