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Received:November 28, 2019 Published Online:July 20, 2020
Received:November 28, 2019 Published Online:July 20, 2020
中文摘要: :目的 探讨血浆D-二聚体水平与慢性阻塞性肺疾病(COPD)伴低危肺栓塞患者预后的相关性。
方法 选择2016年1月至2018年9月确诊的COPD患者117例为研究对象,根据COPD患者是否伴低危肺栓塞分为COPD组55例和COPD伴肺栓塞组62例;选择门诊健康体检者52例作为对照组。测定三组研究对象血浆D-二聚体水平、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、C反应蛋白(CRP)、白细胞(WBC),
肺功能仪测定第1秒用力呼气容积占预计值百分比(FEV1%),FEV1占用力肺活量的百分比(FEV1/FVC),一氧化碳弥散量(DLCO)。采用多因素Logistic逐步回归分析COPD伴低危肺栓塞患者死亡的危险因素。
结果
PT、APTT、FEV1%、FEV1/FVC、DLCO水平呈COPD伴肺栓塞组<COPD组<对照组,FIB、CRP、WBC、D-二聚体水平呈COPD伴肺栓塞组>COPD组>对照组(P均<0.01);随低氧血症严重程度递增,D-二聚体水平递升(P<0.05);
D-二聚体与FEV1%、FEV1/FVC、DLCO、PT、APTT呈负相关关系,与CRP、WBC、FIB呈正相关关系(P<0.05,P<0.01);高水平D-二聚体及低水平FEV1/FVC、APTT均为COPD伴低危肺栓塞患者发生死亡事件的危险因素(P均<0.01);FEV1/FVC、APTT两者的AUC相近,皆小于D-二聚体;FEV1/FVC、APTT诊断COPD伴低危肺栓塞的灵敏度、特异度相近(P均>0.05),皆低于D-二聚体(P均<0.05)。
结论 血浆D-二聚体水平对COPD伴低危肺栓塞患者诊断和预后评价具有重要价值。
Abstract:Objective To investigate the relationship between the level of plasma D-dimer(D-D) and the prognosis of patients with chronic obstructive pulmonary disease(COPD) and low-risk pulmonary embolism(PE).
Methods A total of 117 COPD patients from January 2016 to September 2018 were selected and divided into COPD group (n=55) and COPD with PE group (n=62) according to whether the patients had low-risk PE or not.In the same period,52 healthy outpatients were served as control group.The levels of plasma D-D,PT,APTT,FIB,CRP,WBC,forced expiratory volume in 1s as a percentage of predicted value(FEV1% pred),forced expiratory volume in 1s as a percentage of forced vital capacity(FEV1/FVC) and diffusing capacity of the lung for carbon monoxide(DLCO) were measured among three groups.Multivariate Logistic stepwise regression was used to investigate the risk factors of death in COPD patients with low-risk PE.
Results PT,APTT,FEV1%,FEV1/FVC and DLCO decreased in the order of control group,COPD group and COPD with PE group(all P<0.01),and FIB,CRP,WBC and D-D increased statistically in the order of control group,COPD group and COPD with PE group(all P<0.01).D-D level statistically increased with the increase of hypoxemia severity(P<0.05).D-D was negatively correlated with FEV1%,FEV1/FVC,DLCO,PT,APTT,and was positively correlated with CRP,WBC and FIB(P<0.05,P<0.01).High level of D-D and low levels of FEV1/FVC and APTT were the risk factors for death in COPD patients with low-risk PE(all P<0.01).The areas under ROC curves (AUC) of FEV1/FVC and APTT were similar,but less than D-D.In the diagnosis of COPD patients with low-risk PE,the sensitivity and specificity of FEV1/FVC and APTT were similar (all P>0.05),and both were less than those of D-D (all P<0.05).
Conclusion The plasma D-D plays an important role in the diagnosis and prognosis of COPD patients with low-risk PE.
文章编号: 中图分类号: 文献标志码:B
基金项目:2018年度张家口市科技计划项目(1821095D)
Author Name | Affiliation |
CAO Xiu-li,LI You-xiang | Department of Respiratory,Zhangjiakou First Hospital,Zhangjiakou,Hebei 075000,China |
Author Name | Affiliation |
CAO Xiu-li,LI You-xiang | Department of Respiratory,Zhangjiakou First Hospital,Zhangjiakou,Hebei 075000,China |
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