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目的探讨心肌型脂肪酸结合蛋白(heart-type fatty acid-binding protein,H-FABP)联合急性生理学与慢性健康状况评分(acute Physiology and Chronic Health Evaluation,APACHEⅡ)在评估急性肺栓塞(acute pulmonary embolism,APE)患者病情严重程度及预后的临床价值。方法回顾性分析本院2010年1月至2015年1月确诊的160例APE患者临床资料[男92例,女68例,年龄(51±12)岁]。根据APE患者病情严重程度将其分为:低危组[n=58,男33例,女25例,年龄(50±13)岁]、中危组[n=54,男30例,女24例,年龄(54±12)岁]及高危组[n=48,男29例,女19例,年龄(52±10)岁];根据临床转归,将其分为存活组(n=132)和死亡组(n=28),比较不同组间H-FABP和APACHEⅡ评分的差异,评价H-FABP(酶联免疫吸附法测定)和APACHEⅡ评分对评估APE患者病情严重程度及预后的临床价值。结果随着APE患者病情严重程度的增加,H-FABP和APACHEⅡ评分指标水平显著升高(P<0.05);死亡组H-FABP和APACHEⅡ评分水平显著高于存活组(P<0.05)。相关性分析显示,血浆H-FABP与APACHEⅡ评分水平呈正相关(r=0.71,P=0.000)。ROC曲线分析显示,H-FABP曲线下面积为0.854(95%CI 0.784~0.927),其血浆H-FABP>13.3μg/L时,诊断APE的病情严重程度及预后的敏感性和特异性分别为81.0%和79.4%;APACHEⅡ评分曲线下面积为0.861(95%CI 0.812~0.932),其APACHEⅡ评分>19.2分时诊断APE的病情严重程度及预后的敏感性和特异性分别为77.8%和80.4%。二者指标串联诊断敏感性及特异性分别为88.9%和87.6%,ROC曲线下面积为0.914(95%CI 0.825~0.948),其明显高于单一H-FABP和APACHEⅡ评分指标。结论 H-FABP联合APACHEⅡ评分评估APE患者病情严重程度及预后的敏感性及特异性显著优于单一H-FABP和APACHEⅡ评分指标,其可为临床APE患者个体化治疗,降低其病死率提供客观依据。
Objective To investigate the clinical value of H-FABP combined with acute physiology and Chronic Health Evaluation (APACHEⅡ) in the assessment of acute pulmonary embolism (APE ) Patients with the severity and prognosis of clinical value. Methods The clinical data of 160 patients with APE diagnosed in our hospital from January 2010 to January 2015 were retrospectively analyzed. There were 92 males and 68 females, aged 51 ± 12 years. According to the severity of APE, the patients were divided into low risk group (n = 58, male 33, female 25, age 50 ± 13) (54 ± 12) years old and high risk group (n = 48, 29 males and 19 females, 52 ± 10 years old). According to the clinical outcome, they were divided into survival group (n = 132) ) And death group (n = 28). The differences of H-FABP and APACHEⅡ scores among different groups were compared to evaluate the clinical value of H-FABP and APACHEⅡscores in assessing the severity and prognosis of patients with APE . Results The H-FABP and APACHEⅡ scores increased significantly with the severity of APE (P <0.05). The levels of H-FABP and APACHEⅡ in death group were significantly higher than those in survival group (P <0.05). Correlation analysis showed that there was a positive correlation between plasma H-FABP and APACHEⅡscore (r = 0.71, P = 0.000). ROC curve analysis showed that the area under the curve of H-FABP was 0.854 (95% CI 0.784-0.927), and the sensitivity and specificity of diagnosing the severity and prognosis of APE when plasma H-FABP> 13.3μg / L were 81.0%, and 79.4% respectively. The area under the APACHEⅡscore curve was 0.861 (95% CI 0.812-0.932). The APACHEⅡ score> 19.2 was 77.8% and 80.4%, respectively. . The sensitivity and specificity of the tandem diagnostic criteria for the two markers were 88.9% and 87.6%, respectively. The area under the ROC curve was 0.914 (95% CI 0.825-0.948), which was significantly higher than the single H-FABP and APACHE II scores. Conclusions The sensitivity and specificity of H-FABP combined with APACHEⅡ score in evaluating the severity and prognosis of patients with APE are significantly better than those of single H-FABP and APACHEⅡ scores, which may provide an objective basis for individualized treatment and reduction of mortality in APE patients .