摘要
目的探究血栓弹力图及血小板分布宽度(PDW)、D-二聚体/纤维蛋白原(DFR)预测慢性阻塞性肺疾病急性加重期(AECOPD)合并肺栓塞发生的价值。方法选取2023年4月至2024年5月邢台市中心医院130例AECOPD患者,发生肺栓塞的58例患者纳入栓塞组,未发生肺栓塞的72例患者纳入非栓塞组。对比两组患者基线资料、血栓弹力图参数以及PDW、DFR,采用Pearson相关分析法分析血栓弹力图参数与PDW、DFR及血小板计数(PLT)的相关性;采用二元Logistic回归模型方程分析AECOPD患者合并肺栓塞的相关影响因素;采用受试者工作特征(ROC)曲线分析血栓弹力图及PDW、DFR对AECOPD合并肺栓塞发生的预测价值。结果与非栓塞组比较,栓塞组患者吸烟史的比例、PLT、血栓弹力图参数中的最大振幅(MA)和α角、PDW和DFR均显著升高(P<0.05),而其凝血反应时间(R-time)和凝血形成时间(K-time)则显著降低(P<0.05)。MA和α角与PDW、DFR及PLT水平均呈显著正相关(P<0.05),而R-time和K-time则与这3项指标均呈显著负相关(P<0.05)。二元Logistic回归分析显示,血栓弹力图参数(K-time,R-time,MA,α角)以及PDW、DFR均为AECOPD患者合并肺栓塞的独立相关影响因素(P<0.05)。ROC曲线分析显示,MA、K-time、R-time、α角、PDW、DFR单独预测AECOPD合并肺栓塞的曲线下面积(AUC)分别为0.706、0.738、0.713、0.700、0.723、0.729。6项指标联合应用时预测效能显著提高,AUC为0.973,敏感度为89.66%,特异度为54.17%。结论血栓弹力图及PDW、DFR异常可提示AECOPD合并肺栓塞发生。
Objective To explore the predictive value of thromboelastography(TEG),platelet distribution width(PDW),and D-dimer/fibrinogen ratio(DFR)for coexisting pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 130 AECOPD patients admitted to Xingtai Central Hospital from April 2023 to May 2024 were enrolled.Patients were divided into an embolism group(n=58)and a non-embolism group(n=72)based on the occurrence of pulmonary embolism.Baseline characteristics,TEG parameters,PDW,DFR and platelet count(PLT)were compared between groups.Pearson correlation was used to analyze relationships between TEG parameters and PDW,DFR,and PLT.Binary logistic regression identified factors associated with pulmonary embolism in AECOPD.Receiver operating characteristic(ROC)curves evaluated the predictive value of TEG parameters,PDW,and DFR for pulmonary embolism in AECOPD.Results Compared to the non-embolism group,patients in the embolism group exhibited significantly higher proportions of smoking history,PLT,TEG parameters including maximum amplitude(MA)andα-angle,PDW,and DFR(P<0.05),while R-time and K-time were significantly lower(P<0.05).MA andα-angle showed significant positive correlations with PDW,DFR,and PLT levels(P<0.05),whereas K-time and R-time showed significant negative correlations with PDW,DFR,and PLT levels(P<0.05).Binary logistic regression analysis showed that TEG parameters(K-time,R-time,MA,α-angle),PDW,and DFR were all independent influencing factors significantly associated with pulmonary embolism in AECOPD patients(P<0.05).ROC curve analysis indicated that the AUC values for MA,K-time,R-time,α-angle,PDW,and DFR in predicting pulmonary embolism in AECOPD were 0.706,0.738,0.713,0.700,0.723,and 0.729,respectively.The combination of these six indicators achieved significantly enhanced predictive efficacy,with an AUC of 0.973,89.66%sensitivity,and 54.17%specificity.Conclusion Abnormal TEG parameters,PDW and DFR may indicate coexisting pulmonary embolism in AECOPD patients.
作者
邢宁宁
王君畅
李卉
侯伟丽
樊彦卿
XING Ningning;WANG Junchang;LI Hui;HOU Weili;FAN Yanqing(Department of Geriatrics,Xingtai Central Hospital,Xingtai,Hebei 054000,China;Hemodialysis Room,Xingtai Central Hospital,Xingtai,Hebei 054000,China)
出处
《转化医学杂志》
2025年第7期7-12,共6页
Translational Medicine Journal
基金
邢台市重点研发计划项目(2022ZC124)。
关键词
肺疾病
慢性阻塞性
肺栓塞
血栓弹力图
血小板分布宽度
D-二聚体
纤维蛋白原
Chronic obstructive pulmonary disease
Pulmonary embolism
Thromboelastography
Platelet distribution width
D-dimer
Fibrinogen
