摘要
目的 分析急性肺栓塞(APE)患者血清学指标并构建APE筛查模型.方法 回顾性选择2022年2月至2023年9月在杭州市富阳区第一人民医院疑诊为APE的患者100例,根据CT肺血管造影结果分为观察组41例和对照组59例,比较两组患者一般资料,血缺血修饰白蛋白(IMA)、D-二聚体、同型半胱氨酸(Hcy)和动脉血氧分压水平,采用多因素logistic回归分析APE的独立影响因素,建立APE筛查模型,采用ROC曲线评价APE筛查模型的诊断效能.结果 观察组患者呼吸困难、制动、下肢静脉血栓比例,血IMA、D-二聚体、Hcy水平高于对照组,差异均有统计学意义(均P＜0.05).多因素logistic回归分析显示,呼吸困难、制动、下肢静脉血栓、血IMA、D-二聚体和Hcy均是APE的独立影响因素(均P＜0.05).ROC曲线结果显示APE筛查模型的诊断效能较高(AUC=0.945,95%CI:0.894～0.996,P＜0.05),最佳阈值为 43.5分,APE筛查模型的灵敏度、特异度、阳性预测值、阴性预测值分别为0.966、0.854、0.946、0.905.结论 本研究构建的APE筛查模型预测能力较好,有待临床进一步验证.
Abstract
Objective To establish a screening model for acute pulmonary embolism(APE)based on clinical symptoms and serological indicators.Methods A total of 100 patients suspected of APE in the First People's Hospital of Fuyang Hangzhou,from February 2022 to September 2023 were selected retrospectively.The patients were categorized into observation group(41 cases)and control group(59 cases)based on CT pulmonary angiography.The history of smoking and drinking,chest pain,dyspnea,hemoptysis,syncope,tumor,immobilization and deep vein thrombosis of lower limbs,and ischemia-modified albumin(IMA),D-dimer,homocysteine(Hcy)and arterial oxygen partial pressure were compared between the two groups.Independent risk factors for APE were identified using logistic regression analysis and an APE screening model was established.The diagnostic value of the APE screening model was assessed using ROC curve.Results The proportion of dyspnea,immobilization,and deep vein thrombosis of the lower limbs,and the levels of IMA,D-dimer and Hcy were significantly higher in observation group than control group.(all P＜0.05).Logistic regression analysis revealed that dyspnea,immobilization,deep vein thrombosis of lower limbs,IMA,D-dimer and Hcy were independent risk factors for APE(all P＜0.05).The ROC curve analysis indicated that the APE screening model had a high diagnostic efficacy(AUC=0.945,95%CI:0.894-0.996,P＜0.05),with an optimal threshold of 43.5.The sensitivity,specificity,positive predictive value and negative predictive value of the APE screening model were 0.966,0.854,0.946 and 0.905,respectively.Conclusion The APE screening model constructed in this study has good predictive ability and needs further clinical validation.
NETL
NSTL
万方数据