目的：探讨血栓负荷在急性中危肺血栓栓塞症（PTE）中的临床意义。方法：回顾性分析2019年01月―2022年01月期间入住湖南省人民医院经CT肺动脉造影（CTPA）检查确诊为急性中危PTE患者128例,根据危险分层分为中低危、中高危两组,中低危组66例,中高危组62例。比较两组一般临床资料、超声心动图右心室内径（RV）、左心室内径（LV）、CTPA RV、LV和血栓负荷/CT肺动脉阻塞指数（PAOI）Qanadli评分。比较血栓负荷Qanadli评分与CTPA和超声心动图RV/LV比值的相关性,用受试者工作特征曲线（ROC）分析Qanadli评分对中危PTE危险分层的预测能力。结果：中低危PTE组与中高危PTE组年龄及性别两组之间均无统计学差异。中低危PTE组在气促、晕厥临床症状和伴随疾病肾功能不全、下肢深静脉血栓形成（DVT）与中高危PTE组比较差异显著,具有统计学意义。中低危组患者Qanadli评分、CTPA和超声心动图RV/LV比值明显低于中高危组患者。Qanadli评分与CTPA和超声心动图RV/LV比值呈正相关。Qanadli评分对中高危PTE具有较好预测价值,其ROC曲线下面积（AUC）为0.814,截断值为32.5%,灵敏度为77.3%,特异度为77.4%。单因素二元logsitic回归分析结果显示与低Qanadli评分（<32.5%）患者相比,高Qanadli评分（≥32.5%）危险分层为中高危的概率显著增加（OR=11.657）。结论：Qanadli评分是中低危和中高危PTE危险分层的预测因子,为中危PTE危险分层提供有力补充,为临床医生及时准确评估患者病情严重程度和个体化治疗提供参考价值。
Abstract
Objective To investigate the clinical value of thrombotic load in acute intermediate-risk pulmonary thromboembolism (PTE). Methods A retrospective analysis was conducted on 128 patients admitted to Hunan Provincial People's Hospital who were diagnosed with acute intermediate-risk PTE by CT pulmonary angiography (CTPA) examination, and who were divided into intermediate-low-risk group and intermediate-high-risk group according to the risk stratification, including 62 cases in intermediate-high-risk and low risk group and 66 cases in intermediate-low-risk group, and who were analyzed in the general clinical data, right ventricular inner diameter (RV) and left ventricular inner diameter (LV) of echocardiography, RV and LV and thrombotic load/CT pulmonary artery occlusion index (PAOI) Qanadli score of CTPA. Qanadli score for thrombotic load and the RV/LV ratio of CTPA and echocardiography were compared. Receiver operating characteristic curve (ROC) was used to analyze the predictive ability of Qanadli score for acute intermediate-risk PTE. Results There were no statistical differences in age and sex of intermediate-low-risk group and intermediate-high-risk group. There were significant differences in shortness of breath, syncope and concomitant disease renal insufficiency, DVT in the two groups. Qanadli score, RV/LV ratios of CTPA and echocardiogram of patients in intermediate-low-risk group were significantly lower than those in intermediate-high-risk group. Qanadli score was positively correlated with RV/LV ratios of CTPA and echocardiographic. Qanadli score had good predictive value for intermediate-high-risk PTE, with an area under the ROC curve (AUC) of 0.814, a truncation value of 32.5%, a sensitivity of 77.3%, and a specificity of 77.4%. The result of univariate logsitic regression analysis showed that the high Qanadli scores (≥32.5%) were significantly more likely to be intermediate-high-risk than the low Qanadli scores (<32.5%) (OR=11.657). Conclusion Qanadli score was a predictor of risk stratification of intermediate-risk PTE, which provided a strong supplement for risk stratification, and reference value for clinicians who timely and accurately assessed the severity of the disease and personalized treatment.
关键词
肺血栓栓塞症 /
CT肺动脉阻塞指数 /
Qanadli评分 /
血栓负荷
Key words
pulmonary thromboembolism /
CT pulmonary artery obstruction index /
Qanadli score /
thrombotic load
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参考文献
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基金
湖南省重点研发计划（编号：2019SK2021）,湖南省卫计委重点项目（编号：20200339）
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