肺栓塞严重指数联合心肌肌钙蛋白I对早期血压正常急性肺栓塞预后的预测价值

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APE30d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。

Predictive Value of the Pulmonary Embolism Severity Index and the Troponin I Assay in Hemodynamically Stable Patients with Acute Pulmonary Embolism

Objective：To explore the prognostic value of the acute pulmonary embolism （APE） severity index （PESI） and the cardiac troponin I （cTnI） assay in hemodynamically stable patients with APE. Methods：The 30-days adverse events of hemodynamically stable patients with APE from Jan 2009 to Dec 2012 were analyzed by different stratification with PESI and cTnI. Results： 165 haemodynamically stable patients with APE were investigated： the PESI with high-risk ≥ 86 points were 103 （62.4%） cases,cTnI ≥0.1 ng/ml were 98 （59.4%）cases. 75 （45.5%） cases were identified as high risk group by a PESI （≥ 86 points） and cTnI （≥0.1 ng/ml）, 42 （25.5%） cases were identified as low risk group by a PESI of ≤85 points and cTnI〈0.1 ng/ml on admission. The PESI（ ≥86 points）,the same as cTnI （≥0.1 ng/ml） was associated with a high prognostic sensitivity （89%） and NPV （97%）. The combination of the biomarker with the clinical score was associated with an excellent prognostic specifcity（93%）,PPV （98%） and PLR（9.57）. Conclnsions：The PESI and cTnI assay have the prognostic value for hemodynamically stable patients with APE respectively, and combination of the PESI and cTnI assay may improve prognostic information and particularly identify possible low-risk cases in 30-days.