血清Hcy、D-D、FIB联合预测急性肺血栓栓塞患者远期预后不良的价值探讨

目的探讨血清同型半胱氨酸(Hcy)、D-二聚体(D-D)、纤维蛋白原(FIB)联合预测急性肺血栓栓塞(PTE)患者远期预后不良的价值。方法回顾性分析2018年3月~2019年10月本院收治的142例急性PTE经常规治疗后出院患者的临床资料,随访6个月,统计远期预后不良发生情况;对比预后不良组和预后良好组治疗前后血清Hcy、D-D、FIB水平及变化率;制作受试者工作特征曲(ROC),分析血清Hcy、D-D、FIB变化率及三者联合对急性PTE患者远期预后不良的预测效能。结果本研究中急性PTE患者预后不良的发生率为21.83%(31/142);治疗后2组患者血清Hcy、D-D、FIB水平均降低(P<0.05),且预后良好组较预后不良组均更低(P<0.05),预后不良组血清Hcy、D-D、FIB变化率均明显低于预后良好组(P<0.05);ROC分析显示,血清Hcy、D-D、FIB变化率预测急性PTE患者远期预后不良的最佳截断点分别为18.01%、55.43%、20.64%,血清Hcy、D-D、FIB变化率三者联合的特异度高于血清Hcy、D-D、FIB变化率单独进行预测的特异度(P<0.05),且血清Hcy、D-D、FIB变化率三者联合预测急性PTE患者远期预后不良的曲线下面积(AUC)为0.932,高于血清Hcy、D-D、FIB变化率单独预测的AUC(P=0.067、P=0.153、P=0.021)。结论血清Hcy、D-D、FIB联合预测急性PTE患者远期预后不良的预测效能较高,三者变化率联合适用于对急性PTE患者远期预后不良进行预测。

Value of serum Hcy,D-D and FIB in predicting poor long-term prognosis of patients with acute pulmonary thromboembolism

Objective To explore the value of serum homocysteine(Hcy),D-Dimer(D-D)and fibrinogen(FIB)in predicting the long-term prognosis of patients with acute pulmonary embolism(PTE).Methods The clinical data of 142 patients with acute PTE discharged after regular treatment in our hospital from March 2018 to October 2019 were retrospectively analyzed.The patients were followed up for 6 months,and the long-term adverse prognosis was counted.The serum Hcy,D-D,FIB levels and the change rate were compared between the poor prognosis group and the good prognosis group before and after treatment.Receiver operating characteristic curve(ROC)was made to analyze the change rate of serum Hcy,D-D and FIB,and the predictive efficacy of the combination of the three on the long-term poor prognosis of patients with acute PTE.Results The incidence of poor prognosis in patients with acute PTE was 21.83%(31/142).After treatment,the levels of serum Hcy,D-D and FIB in the two groups were decreased(P<0.05),and the prognosis in the good prognosis group was lower than that in the poor prognosis group(P<0.05).The change rates of serum Hcy,D-D and FIB in the poor prognosis group were significantly lower than those in the good prognosis group(P<0.05).ROC analysis showed that the best cut-off points for predicting the long-term poor prognosis of acute PTE patients were 18.01%,55.43%and 20.64%,respectively.The specificity of the combination of serum Hcy,D-D and FIB change rate was higher than the specificity of serum Hcy,D-D and FIB change rate separately predicted(P<0.05),and the area under curve(AUC)of the change rate of serum Hcy,D-D and FIB in predicting the long-term poor prognosis of patients with acute PTE was 0.932,which was higher than the AUC predicted by the change rate of serum Hcy,D-D and FIB(P=0.067,P=0.153,P=0.021).Conclusion The combination of serum Hcy,D-D and FIB can predict the long-term poor prognosis of patients with acute PTE,of which the change rates can be used to predict the long-term poor prognosis of patients with acute PTE.