摘要目的:观察不同危险等级老年肺栓塞患者临床实验室检测结果的变化，评价其独立及联合分层诊断性能。方法:纳入2012—2020年北京医院及十二五肺栓塞注册登记研究部分医院的老年肺栓塞住院患者数据，比较不同危险等级患者间43个临床体征及检测指标的差异，采用单因素及多因素Logistic线性回归分析差异指标在不同危险等级间的独立及联合诊断效能，并绘制受试者工作特征曲线(ROC)。结果:多组检验及两两比较结果显示，4组患者间有33个指标的差异有统计学意义，高、中、低危3组患者间有29个指标差异有统计学意义，高危、非高危两组患者之间有21个指标差异有统计学意义。高危与非高危分层诊断中，单因素分析14个指标的ROC分析曲线下面积(AUC)为0.611～0.802；多因素分析结果显示，收缩压(SBP)、白细胞计数(WBC)和天门冬氨酸氨基转移酶(AST)联合诊断AUC可达0.859(95% CI：0.795～0.924)；中危与低危分层诊断中，单因素分析12项指标的ROC分析曲线下面积(AUC)为0.592～0.835，其中B型尿钠肽(BNP)及N末端BNP前体的独立诊断有助于中危和低危肺栓塞危险分层；而多因素分析结果显示未发现AUC显著提高的联合诊断模型。 结论:不同危险等级老年肺栓塞患者的基本生命体征、血气分析、凝血功能、肝肾功能及心肌标志物等多种临床检验指标的差异均有统计学意义，SBP、WBC与AST的联合诊断有助于高危和非高危肺栓塞危险分层。

abstractsObjective:To investigate the changes in clinical signs and laboratory testing results and their risk-tiring diagnostic effectiveness in elderly patients with pulmonary embolization (PE) with different risk levels.Methods:A retrospective analysis was conducted on the clinical data of elderly hospitalized PE patients in Beijing Hospital and other coordinated hospital from 2012 to 2020.Differences in 43 clinical signs and detection indicators between patients with four different risk levels were compared.The univariate and multivariate regression models were used to analyze differences between high-risk and non-high-risk PE and between intermediate-risk and low-risk PE with ROC analysis.Results:In the multi-group comparison, there are 33 clinical tests having significant differences between four risk groups, 29 clinical tests having significant differences between three risk groups(high, intermediate and low groups), and 21 clinical tests having significant differences between two groups(high and non-high groups). In the ROC analysis of risk stratification in high-risk and non-high-risk groups, it was found that the range of area under the curves(AUC)of 14 significantly changed clinical tests were 0.611 to 0.802 in the univariate regression analysis.The AUC of the model of systolic blood pressure(SBP)combined with white blood cell count(WBC)and aspartate aminotransferase(AST)was 0.8593(95% CI: 0.795-0.924)in the multivariate regression analysis.While in the ROC analysis between intermediate-risk and low-risk, the range of AUC of 12 significantly changed clinical tests were 0.592 to 0.835 in the univariate regression analysis.The B-type natriuretic peptide(BNP)and N-terminal B-type natriuretic peptide(NT-proBNP)can assist the risk stratification in intermediate-risk and low-risk PE groups.No efficient combined diagnosis model was found. Conclusions:The basic vital signs and multiple clinical laboratory tests were significantly different among four risk levels of elderly PE patients, such as blood gas analysis, coagulative function, liver and kidney function and myocardial markers.The combination of SBP, WBC, and AST can effectively assist the risk stratification in high-risk and non-high-risk PE groups.