右心功能不全对肺血栓栓塞症患者的预后价值及临床预后模型的建立

朱玲; 王辰; 杨媛华; 吴雅峰; 翟振国

Abstract

朱玲,王辰,杨媛华,吴雅峰,翟振国.右心功能不全对肺血栓栓塞症患者的预后价值及临床预后模型的建立[J].Chinese journal of Epidemiology,2009,30(2):184-188

右心功能不全对肺血栓栓塞症患者的预后价值及临床预后模型的建立

Prognostic value of right ventricular dysfunction and derivation of a prognostic model for patients with acute pulmonary thromboembolism

Received:October 19, 2008

DOI：

KeyWord: 肺血栓栓塞症右心功能不全预后模型经胸超声心动图

English Key Word: Pulmonary thromboembolism Right ventricular dysfunction Prognostic model Transthoracic echocardiography

FundProject:国家"十五"科技攻戈课题资助项目(2004BA703807)

Author Name	Affiliation	E-mail
ZHU Ling	山东省立医院呼吸科
WANG Chen	Beijing Institute of Respiratory Medicine, Beqing Chao-yang Hospital, Capital Medical University, Bering 100020, China	Email:cyh-birm@263.net
YANG Yuan-hua	Beijing Institute of Respiratory Medicine, Beqing Chao-yang Hospital, Capital Medical University, Bering 100020, China	Email:yyh1031@sina.com
WU Ya-feng	Beijing Institute of Respiratory Medicine, Beqing Chao-yang Hospital, Capital Medical University, Bering 100020, China
ZHAI Zhen-guo	Beijing Institute of Respiratory Medicine, Beqing Chao-yang Hospital, Capital Medical University, Bering 100020, China

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Abstract:

运用超声心动图评价右心功能不全(RVD)对急性肺血栓栓塞症(PTE)患者的预后价值，并建立临床预后模型。方法采用前瞻性多中心随机对照研究，入选520例急性PTE住院患者，观察入院后14d及3个月的病情发展情况，评价RVD及其他临床特征对PTE的预后价值。

English Abstract:

Acute pulmonary thromboembolism(PTE)patients with right ventricular dysfunction(RVD)may benefit from thrombolytic therapy but may end up with worse prognosis.RVD was assessed in prognosis to which a model on it was constructed to decide the indexes correlated to the best prognosis.Methods This prospective study included 520 consecutive acute PTE patients from 41 hospitals in China between June 2002 and February 2005.All the patients were evaluated by transthoracic echocardiography(TTE),CT pulmonary angiography(CTPA),laboratory tests,and blood gas analysis.Physicians were asked to record all the clinical manifestations.Data from Univariate analysis demonstrated the parameters correlated with an 14-day clinically adverse outcomes.Multiple logistic regression analysis was used to decide the independent predictors and to construct a prognostic model.Results Mcan age of the patients was 57.4±14.1 years and 323 of them(62.1%)were male.The 14-day mortality in normotensive patients with RVD was higher(2.0%vs0.4%,P＜0.01)than those without.ROC curve showed the best cut.ofr values of RVED/LVED and SPAP for 14-day prognosis were 0.67 and 60 mm Hg,respectively.SPAP independently predicted 3-month clinicaI outcomes(P＜0.01).Results from Univariate analysis demonstrated tllat 24 parameters were correlated with an adverse 14-day clinical outcomes.which include palpation,syncope,panic,cyanosis,respiratory rate≥30/min,pulse≥110/min,jugular vein,accentuation of P2,murmurs in tricuspid area,time interval from onset,creatine phosphokinase(CPK),lactate dehydrogenase (LDH).alveolar-arterial PO2 difierence(PA-aO2),white blood cell(WBC)＜4.0×109/L or＞10.0×109/L,platelet.thrombus on TTE,RV/LV＞1.1,TRPG＞30 mm Hg,IVCmin＜8 mm,RVD,RVED/LVED＞0.6,SPAP＞60 mm Hg.RVWM.PTE range larger than two lobes or seven segments on CTPA.Furthermore,a multiple logistic regression model implied 8 predictors including RVD,RVED/LVED＞0.6,SPAP＞60 mm Hg,pulse≥110/min,accentuation of P2,Syncope,CPK,WBC＜4.0×109/L or＞10.0×109/L be independent predictors of an 14-day clinically adverse outcome(P＜0.01).This model seemed to fit well (P＜0.001).Wle chose a cut-off value as P≥0.2 and compared the model to the original derivation samples.Data showed that the sensitivity(true positive rate)was 81.82%,specificity was 92.11%.false positive rate was 18.18%.coincidence was 91.14%.and the concordarlCe rate was 80.96%.Conclusion RVD seemed a nice discriminator for poor prognosis in norrnotensive patients.Early detection of RVD(especially RVED/LVED＞0.67 and/or SPAP＞60 mm Hg)was beneficial for identifying patients at high-risk and the multiple logistic regression model(P＜0.001)could be well fitted.

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