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目的:探讨肺栓塞严重指数(PESI)、心肌钙蛋白I(cTnI)对早期血压正常急性肺栓塞(APE)预后的预测价值。方法:利用PESI评分、cTnI定量对2009年01月-2012年12月确诊的早期血压正常APE患者进行分组,观察30d内不良事件发生情况,分析不同分层方法对早期血压正常APE患者预后的预测价值。结果:165例患者入选,PESI高危103例(62.4%)、低危62例(37.6%),cTnI阳性98例(59.4%)、cTnI阴性67例(40.6%),PESI高危且cTnI阳性75例(45.5%)、PESI低危且cTnI阴性42例(25.5%)。PESI高危组或cTnI阳性组(89%)和阴性预测值(97%),联合分层对不良预后预测的敏感性93%、阳性预测值(98%)和阳性似然比9.57。结论:PESI、cTnI对早期血压正常的APE 30 d内预后有一定预测价值,二者联合可提高对30d内低危风险患者识别的敏感性及特异性。
Objective: To investigate the predictive value of PESI and cTnI in the prognosis of patients with early normotensive pulmonary embolism (APE). Methods: PESI score and cTnI were used to quantify early normotensive patients with APE diagnosed from January 2009 to December 2012. The incidence of adverse events within 30 days was observed, and the prognosis of early normotensive patients with APE was analyzed by different stratified methods value. Results: A total of 165 patients were enrolled. The high risk of PESI was 103 cases (62.4%), the low risk was 62 cases (37.6%), cTnI positive was 98 cases (59.4%), cTnI negative was 67 cases (45.5%), low risk of PESI and cTnI negative in 42 cases (25.5%). PESI high risk group or cTnI positive group (89%) and negative predictive value (97%), combined stratification of poor prognosis of 93% sensitivity, positive predictive value (98%) and positive likelihood ratio of 9.57. CONCLUSION: PESI and cTnI have some predictive value in early stage of nocturnal normotensive APE. The combination of PESI and cTnI can improve the sensitivity and specificity of identification in patients with low risk within 30 days.