2023 年第 5 期 第 18 卷

休克指数和N末端B型脑钠肽前体及右心室直径对急性中危肺血栓栓塞症危险分层的评估价值

Evaluative value of shock index, N-terminal pro-brain natriuretic peptide and right ventricular diameter for risk stratification of acute intermediate risk pulmonary thromboembolism

作者：石莉芳1江刚1彭优1陈博1欧阳雯1佘志远1郑昭芬2

英文作者：Shi Lifang1 Jiang Gang1 Peng You1 Chen Bo1 Ouyang Wen1 She Zhiyuan1 Zheng Zhaofen2

单位：1湖南师范大学附属第一医院湖南省人民医院呼吸与危重症医学科，长沙410000；2湖南师范大学附属第一医院湖南省人民医院心血管内科，长沙410000

英文单位：1Department of Respiratory and Critical Care Medicine the First Affiliated Hospital of Hunan Normal University Hunan Provincial People′s Hospital Changsha 410000 China; 2Department of Cardiology the First Affiliated Hospital of Hunan Normal University Hunan Provincial People′s Hospital Changsha 410000 China

关键词：肺血栓栓塞症；休克指数；N末端B型脑钠肽前体；右心室直径

英文关键词：Pulmonarythromboembolism;Shockindex;N-terminalpro-brainnatriureticpeptide;Rightventriculardiameter

• 摘要：

• 目的 探讨休克指数、N末端B型脑钠肽前体（NT-proBNP）、超声心动图和CT肺动脉造影(CTPA)检测右心室直径（RV）对急性中危肺血栓栓塞症（PTE）危险分层的评估价值。方法 回顾性分析湖南省人民医院2018年1月至2021年1月住院的100例急性中危PTE患者的临床资料，根据危险分层分为中低危组（34例）和中高危组（66例）。收集所有患者的实验室数据及临床资料，采用二元Logistic回归方法分析急性中危PTE危险分层的独立危险因素；用受试者工作特征曲线分析各独立危险因素对急性中高危PTE的预测能力。结果  中高危组患者的心肌肌钙蛋白I、休克指数、NT-proBNP水平明显高于中低危组患者，动脉血氧分压、氧合指数水平明显低于中低危组患者（均P＜0.05）。中高危组超声心动图检测的RV、RV/左心室直径（LV）比值、三尖瓣反流速度和肺动脉收缩压均明显高于中低危组，差异均有统计学意义(均P＜0.05)。中高危组患者CTPA检测的RV、RV/LV比值、主肺动脉内径、血栓负荷均明显高于中低危组，差异均有统计学意义（均P＜0.05）。多因素二元Logistic回归分析结果显示，休克指数、NT-proBNP、超声心动图RV和CTPA RV均是中高危PTE的独立预测因子（均P＜0.05）。4个指标联合预测中高危PTE的曲线下面积为0.984，敏感度和特异度分别为90.32%和97.73%。结论   休克指数、NT-proBNP、超声心动图RV和CTPA RV均是急性中高危PTE的独立预测因子，4个指标联合有助于急性中危PTE的危险分层评估。

• Objective  To investigate the evaluative value of shock index, N-terminal pro-brain natriuretic peptide (NT-proBNP), right ventricular diameter (RV) measured by echocardiography and CT pulmonary angiography (CTPA) for risk stratification of acute intermediate risk pulmonary thromboembolism (PTE). Methods From January 2018 to January 2021, the clinical data of 100 patients with acute intermediate risk PTE in Hunan Provincial People′s Hospital were retrospectively analyzed. They were divided into intermediate low-risk group (34 cases) and intermediate high-risk group (66 cases) according to risk stratification. Laboratory data and clinical data of all patients were collected, and binary Logistic regression analysis was used to analyze independent risk factors for risk stratification of acute intermediate risk PTE. The predictive ability of each independent risk factor for acute intermediate high-risk PTE was analyzed by receiver operating characteristic curve. ResultsThe intermediate high-risk group had significantly higher levels of cardiac troponin I, shock index and NT-proBNP, and lower levels of arterial partial pressure of oxygen and oxygenation index than those in the intermediate low-risk group (all P＜0.05). RV, RV/left atrial diameter (LV), tricuspid regurgitation velocity, and pulmonary artery systolic pressure detected by echocardiography in the intermediate high-risk group were significantly higher than those in the intermediate low-risk group(all P＜0.05). RV, RV/LV, internal diameter of the main pulmonary artery, and thrombus burden detected by CTPA were significantly higher in the intermediate high-risk group than those in the intermediate low-risk group(all P＜0.05). The results of multivariate binary Logistic regression analysis showed that shock index, NT-proBNP, RV measured by echocardiography and CTPA were all independent predictors of intermediate high-risk PTE (all P＜0.05). The area under the curve for the combined prediction of intermediate high-risk PTE by those four indexes was 0.984, and the sensitivity and specificity were 90.32% and 97.73% respectively. Conclusions The shock index, NT-proBNP and RV measured by echocardiography and CTPA are independent predictors of acute intermediate high-risk PTE. Those provide a powerful supplement for the risk stratification of acute intermediate risk PTE.