sPESI联合hs-TnT对血流动力学稳定肺栓塞患者短期预后的评估价值

摘要

目的 探讨简化肺栓塞严重程度指数(sPESI)联合超敏肌钙蛋白(hs-TnT)对血流动力学稳定的肺栓塞(PE)患者短期预后的评估价值.方法 纳入99例血流动力学稳定的PE患者,sPESI评分≥1分为高危组及sPESI评分=0分为低危组.hs-TnT≥0.014 ng/mL为阳性组与hs-TnT<0.014 ng/mL为阴性组,再进行二者联合分组,对所有研究对象进行标准治疗及30 d的随访,计算各分组预测不良事件的敏感度、特异度、阳性预测值、阴性预测值,绘制ROC曲线,评价各分组方式对PE患者短期预后的评估价值.结果 99例研究对象中,有13例出现不良事件,单项试验可见hs-TnT对PE患者不良事件的预测敏感度为84.6%,特异度55.2%,阳性预测值22%,阴性预测值96%;sPESI对患者预后预测的敏感度92.3%,特异度48.8%,阳性预测值21.1%,阴性预测值97.7%;联合试验敏感度100%,特异度29%,阳性预测值17.6%,阴性预测值100%.sPESI评分曲线下面积AUC=0.832 (95% CI 0.705～0.958),hs-TnT AUC=0.825 (95% CI 0.694～0.957),sPESI联合 hs-TnT AUC=0.872 (95%CI 0.773～0.971).结论 sPESI和hs-TnT在血流动力学稳定的PE患者短期预后的评估中都具有一定价值;sPESI联合hs-TnT评估预后价值优于单独使用,尤其对辨别低危患者具有重要价值.%Objective To explore the value of using sPESI score and hs-TnT in the evaluation of short-term prognosis in hemodynamically stable pulmonary embolism. Methods We collected 99 patients with hemodynamically stable PE from our department. According to the sPESI score and hs-TnT, patients were divided into high risk group (sPESI score≥1) and low risk group (sPESI score=0), positive group (hs-TnT≥0.014 ng/mL) and negative group (hs-TnT＜0.014 ng/mL) . Then all patients were treated and followed up for 30 days. The sensitivity, specificity, positive predictive value and negative predictive value of adverse events of prognosis were calculated, and ROC curve was drawn to analyze the values in different grouping methods for the prognostic evaluation.Results Thirteen adverse events occurred in all patients. The single test showed that sensitivity, specificity, positive predictive value, and negative predictive value of hs-TnT for predicting adverse events were respectively 84.6%,55.2%,22%,and 96%. When sPESI was used alone, sensitivity, specificity, positive predictive value and negative predictive value were 92.3%, 48.8%, 21.1% , and 97.7% . Results of combined testing showed 100% sensitivity, 29% specificity, 17.6% positive predictive value, and 100% negative predictive value. The ROC curve area of the sPESI, hs-TnT, sPESI and hs-TnT are 0.832 (95% CI, 0.705-0.958), 0.825 (95%CI, 0.694-0.957),0.872 (95%CI, 0.773-0.971) . Conclusions PESI and hs-TnT have clinical value in evaluating the short-term prognosis of hemodynamically stable pulmonary embolism. sPESI combined with hs-TnT has higher significance, especially in patients with low-risk PE.