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    前白蛋白、白蛋白与D-二聚体在急性肺栓塞病情严重程度及预后中的预测价值

    Predictive Value of prealbumin, albumin and D-dimer in predicting the severity and prognosis of acute pulmonary embolism

      摘要
    • 摘要: 目的：探讨血清前白蛋白（PALB）、白蛋白（ALB）与D-二聚体（D-Di）在急性肺栓塞（APE）病情严重程度及预后中的预测价值。方法：收集2013 年至2021 年于西南医科大学附属医院首诊为APE 的患者246 例。根据危险分层标准将患者分为低危组81例、中危组122例和高危组43例，根据30 d院内存活情况分为存活组（203例）和死亡组（43例）。分别比较不同病情严重程度及不同预后组的相关指标。采用单因素、多因素logistic 回归法研究APE 患者30 d 内生存预后不良影响因素和独立因素。采用Spearman相关分析法分析比较不同病情严重程度APE患者相关指标与肺栓塞严重指数（PESI）相关性。使用受试者工作特征（ROC）曲线分析PALB 等指标对APE 患者预后转归的预测价值。结果：高危组APE 患者PALB、ALB 水平低于非高危组（P＜0.05）；死亡组患者PALB、ALB 水平低于存活组（P＜0.05）。相关性分析提示，PALB（r=-0.609）、ALB（r=-0.401）与PESI呈负相关关系（均P＜0.001）；hs-TNT（r=0.416）、FIB（r=0.438）、D-Di（r=0.400）与PESI呈正相关关系（均P＜0.001）。单因素和多因素logistic 回归模型分析结果表明，ALB、PALB、D-Di是APE 患者30 d 院内死亡的独立危险因素（P＜0.05）。ROC 分析显示，ALB、PALB、D-Di 对APE 预后均有一定预测价值，且三者联合检测可进一步提高APE 患者预后的预测能力。结论：PALB与APE病情严重程度密切相关，ALB、PALB、D-Di三者联合检测对APE预后具有辅助预测价值。

       

      Abstract: Objective: To explore the predictive value of serum prealbumin (PALB), albumin (ALB) and D-dimer (D-Di) in the severity and prognosis of acute pulmonary embolism (APE).Methods: 246 patients first diagnosed with APE in the Affiliated Hospital of Southwest Medical University from 2013 to 2021 were collected.According to the risk stratification criteria, the patients were divided into low-risk group (81 cases), medium-risk group (122 cases) and high-risk group (43 cases).According to the 30-day in-hospital survival status, the patients were divided into survival group (203 cases) and death group (43 cases).The relevant indicators of different disease severity levels and different prognosis groups were compared.Univariate and multivariate logistic regression methods were used to study the adverse factors and independent factors affecting the survival and prognosis of APE patients within 30 days.Spearman correlation analysis was used to compare the correlation between the relevant indexes of APE patients with different disease severity levels and the pulmonary embolism severity index (PESI).The ROC curve was used to analyze the predictive value of PALB and other indicators on the prognosis of APE patients.Results: The levels of PALB and ALB in APE patients in high-risk group were lower than those in non-high-risk group (P< 0.05).The levels of PALB and ALB in the death group were lower than those in the survival group (P< 0.05).Correlation analysis showed that PALB (r=-0.609) and ALB (r=-0.401) were negatively correlated with PESI (all P< 0.001); hs-TNT (r=0.416), FIB (r=0.438), D-Di (r=0.400) were positively correlated with PESI (all P< 0.001).The analysis of univariate and multivariate logistic regression models showed that ALB, PALB and D-Di were independent risk factors for 30-day hospital death of APE patients (P< 0.05).ROC analysis showed that ALB, PALB and D-Di had certain predictive value for the prognosis of APE, and the combined detection of the three could further improve the predictive ability of the prognosis of APE patients.Conclusion: PALB is closely related to the severity of APE, and the combined detection of ALB, PALB and D-Di has auxiliary predictive value for the prognosis of APE.

       

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