摘要
目的 本研究旨在探究慢阻肺(COPD)合并肺栓塞(PE)患者的风险预测因素及其量化评估方法.方法 选取COPD合并PE患者96 例(PE组),另选取本院同期COPD未合并PE患者96 例(非PE组).收集2 组患者性别、年龄、吸烟史、合并基础病等一般资料以及动脉血二氧化碳分压(PaCO2)、血氧分压(PaO2)、N端脑钠肽前体(NT-proBNP)、D-二聚体(D-dimer)、血清血红蛋白(Hb)及白蛋白(Alb)水平等临床指标.采用单因素及多因素logistic回归分析探讨COPD合并PE的相关影响因素,并构建列线图风险评估模型,同时验证模型的拟合度.结果 2 组患者卧床时间≥7 d、伴静脉血栓、COPD分级、PaO2、D-dimer、NT-proBNP、Alb指标比较,差异有统计学意义(P<0.05).卧床时间≥7 d、COPD分级、D-dimer及NT-proBNP是COPD合并PE的独立危险因素.卧床时间越久、COPD分级越高、PaO2 越低、D-dimer水平越高、NT-proBNP水平越高,发生COPD合并PE的风险越高.验证模型表明,偏差校准曲线与理想曲线吻合良好,该模型的AUC值为0.947,灵敏度为87.5%、特异度为87.5%.结论 长时间卧床、高COPD分级、低PaO2、高D-dimer水平以及高NT-proBNP水平是COPD合并PE的独立危险因素,建立的列线图模型能有效评估患者COPD合并PE的风险.
Abstract
Objective To explore the risk prediction factors and their quantification methods in patients with Chronic Obstruc-tive Pulmonary Disease(COPD)complicated Pulmonary Embolism(PE).Methods A retrospective analysis was conducted on 96 pa-tients diagnosed with COPD complicated by PE(PE group),96 patients with COPD without PE(non-PE group)treated in the same period were selected for comparison.General data were collected included gender,age,smoking history,comorbidities,as well as clinical indicators such as arterial carbon dioxide partial pressure(PaCO2),oxygen partial pressure(PaO2),N-terminal pro-brain natriuretic peptide(NT-proBNP),D-dimer,serum hemoglobin(Hb),and albumin(Alb)levels.Univariate and multivariate logistic regression analyses were used to explore the factors related to COPD complicated by PE,and a nomogram risk assessment model was constructed and its fit verified.Results Univariate analysis indicated significant differences between the two groups in terms of bedridden≥7 days,ac-companying venous thrombosis,COPD classification,PaO2,D-dimer,NT-proBNP,and Alb levels(P<0.05).Logistic regressionanal-ysis showed that bedridden≥7 days,COPD classification,D-dimer,and NT-proBNP were independent risk factors for COPD compli-cated by PE.The risk of developing PE in COPD patients increases with longer bed rest,higher COPD classification,lower PaO2,higher D-dimer levels,and higher NT-proBNP levels.The validation of the model indicated that the calibration curve aligns well with the ideal curve.The AUC value of the model was 0.947,with a sensitivity of 87.5%and a specificity of 87.5%.Conclusion Prolonged bed rest,higher COPD classification,lower PaO2,higher D-dimer levels,and higher NT-proBNP levels are independent risk factors for COPD complicated by PE.The established nomogram model can effectively assess the risk of PE in patients with COPD.
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