hs-cTnI联合GRACE评分在急性肺栓塞患者预后评估中的价值

摘要

Objective To evaluate the prognostic value of high sensitive cardiac troponin I(hs-cTnI)combined with global acute coronary events(GRACE)score in patients with acute pulmonary embolism(APE).Methods A total of 182 APE patients were selected from January 2013 to September 2016 in our hospital.According to the 30 days all-cause mortality they were divided into death group(n=40)and survival group(n=142).According to the GRACE score of acute coronary syndrome patients were divided into low risk group(n=38), middle risk group(n=61)and high risk group(n=83).According to the hs-cTnI results the patients were divided into high hs-cTnI group(hs-cTnI>0.01 ng/mL)with 115 cases and low hs-cTnI group(hs-cTnI ≤0.01 ng/mL)with 67 cases.The levels of hs-cTnI, GRACE score and the incidence of adverse events were compared between the two groups.Univariate and multivariate logistic regression were used to analyze the risk factors of death in patients with APE.Mapping ROC curve was used to evaluate the prognostic value of hs-cTnI and GRACE score in patients with APE.Results The mortality rate of 30 days, hemoptysis and respiratory failure in high hs-cTnI group was significantly higher than that in low hs-cTnI group(P<0.05).The incidence rate of 30 days mortality, hemoptysis and respiratory failure in the high risk group was significantly higher than that in the low risk group(P<0.05).Multivariate 了ogistic regression analysis showed that high hs-cTnI and high GRACE score were independent risk factors for death in patients with APE, and the OR and 95%CI were 1.708(1.259~2.336)and 2.461(1.853~3.286), respectively.The ROC curve showed that the hs-cTnI, GRACE score and the combination of the two predicted 30 days mortality in patients with APE of AUC and 95%CI were 0.767(0.683~0.856), 0.785(0.692~0.884), 0.853(0.761~0.942), and the sensitivity and specificity of the two joint examination for predicting the mortality of patients with APE in the 30 days were the best.Correlation analysis showed that GRACE score was positively correlated with hs-cTnI level(r=0.682, P<0.01).Conclusion Hs-cTnI and GRACE score are independent risk factors for death in patients with APE, and the combination of the two indexes is of better value in the prognosis of patients with APE.%目的 探讨高敏肌钙蛋白I(hs-cTnI)联合全球急性冠状动脉事件注册(GRACE)评分对急性肺栓塞(APE)患者的预后评估价值.方法 选取2013-01~2016-09海南省第三人民医院收治的APE患者182例,根据患者30 d全因病死率将其分为死亡组40例和存活组142例.采用急性冠脉综合征的GRACE评分标准将患者分为低危组38例、中危组61例和高危组83例,依据hs-cTnI测定结果分为高hs-cTnI组(hs-cTnI>0.01 ng/mL)115例和低hs-cTnI组(hs-cTnI≤0.01 ng/mL)67例.比较各组hs-cTnI水平、GRACE评分及不良事件的发生情况,应用单因素及多元Logistic回归分析APE患者死亡的危险因素,并绘制ROC曲线评估hs-cTnI水平及GRACE评分对APE患者的预后价值.结果 高hs-cTnI组30 d死亡、咯血及呼吸衰竭的发生率明显高于低hs-cTnI组(P<0.05),高危组30 d死亡、咯血及呼吸衰竭的发生率明显高于低危组(P<0.05).多元Logistic回归分析显示,hs-cTnI水平高、GRACE评分高是APE患者死亡的独立危险因素,其OR及95%CI分别为1.708(1.259~2.336)、2.461(1.853~3.286).ROC曲线显示,hs-cTnI、GRACE评分及二者联合预测APE患者30 d病死率的AUC及95%CI分别为0.767(0.683~0.856)、0.785(0.692~0.884)、0.853(0.761~0.942),二者联合预测APE患者30 d病死率的敏感度和特异度最好.相关性分析显示,GRACE评分与hs-cTnI水平呈明显正相关(r=0.682,P<0.01).结论 hs-cTnI及GRACE评分是APE患者死亡的独立危险因素,二者联合预测对APE患者预后评估的价值较好.