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目的探讨高敏肌钙蛋白I(hs-c Tn I)阴性结果在筛选急性肺栓塞(APE)低危患者中的预测价值。方法回顾性分析272例在北京安贞医院住院的APE患者的临床资料以及30 d内不良事件发生情况。根据hs-c Tn I测定结果,将患者分为高hs-c Tn I组和低hs-c Tn I组。应用简化肺栓塞严重指数(s PESI)进行临床风险评估。不良事件定义为30 d内死亡、出现严重并发症、需要溶栓治疗或机械通气。绘制不同hs-c Tn I水平组患者的生存曲线。应用多因素Logistic逐步回归模型进行统计分析。结果高hs-c Tn I组30 d内死亡、急性肾功能衰竭、出血及需要溶栓治疗的比例分别为6.1%、14.6%、13.4%和7.9%,均显著高于低hs-c Tn I组(P值分别为0.009、<0.001、0.018和0.003)。在s PESI评分≥1组中,低hs-c Tn I患者不良事件的发生率明显低于高hs-c Tn I患者(P=0.005)。s PESI预测APE患者不良预后的2值为11.25(P=0.001),加入hs-c Tn I后2值升高至26.25(P<0.001)。结论 hs-c Tn I在评估APE短期预后时具有良好的阴性预测价值,且在s PESI基础上可显著增加对APE短期预后的预测能力。
Objective To investigate the predictive value of hs-c Tn I negative results in the screening of low-risk patients with acute pulmonary embolism (APE). Methods The clinical data of 272 APE patients hospitalized in Beijing Anzhen Hospital and the incidence of adverse events within 30 days were retrospectively analyzed. Patients were divided into high hs-c Tn I group and low hs-c Tn I group according to the results of hs-c Tn I assay. Clinical risk assessment was performed using the simplified pulmonary embolism severity index (s PESI). Adverse events were defined as death within 30 days, serious complications, need for thrombolytic therapy or mechanical ventilation. Survival curves of patients with different hs-c Tn I levels were plotted. The multivariate Logistic stepwise regression model was used for statistical analysis. Results The proportion of death, acute renal failure, hemorrhage and thrombolytic therapy within 30 days of high-hs-c Tn I group was 6.1%, 14.6%, 13.4% and 7.9%, respectively, which were significantly higher than those of low hs-c Tn I Group (P values were 0.009, <0.001, 0.018 and 0.003, respectively). The incidence of adverse events was significantly lower in patients with low hs-cTn I than in patients with high hs-cTn I (p = 0.005) in the sPESI score ≥1 group. s PESI predicts a negative prognosis in patients with APE 2 value of 11.25 (P = 0.001), added hs-c Tn I 2 value increased to 26.25 (P <0.001). Conclusion hs-c Tn I has a good negative predictive value in assessing the short-term prognosis of APE, and can significantly increase the predictive ability of short-term APE on the basis of s PESI.