摘要
目的探讨慢性阻塞性肺疾病急性加重(AECOPD)患者发生肺栓塞(PE)的危险因素,构建预测患者并发PE的列线图模型。方法选择2020年5月至2023年5月本院收治的AECOPD患者261例,依据入院24 h内CTPA结果诊断是否发生PE进行分组,PE组78例,非PE组183例。收集一般资料、病情资料、血常规及生化指标行单因素分析,通过Logistic回归分析筛查AECOPD患者发生PE的相关因素。绘制预测患者发生PE列线图模型,并利用ROC曲线下面积(AUC)及校准曲线评价其区分度及准确性。结果78例AECOPD患者发生PE,发生率为29.89%;和非PE组比较,PE组1个月内有手术或骨折史、卧床时间≥1周、合并PAH的患者比例、PaCO_(2)、D-D等因素差异有统计学意义(P<0.05);Logistic回归分析显示,AECOPD患者发生PE的主要危险因素有1个月内有手术或骨折史、卧床时间≥1周、存在PAH、高D-D水平4项;构建预测PE发生的列线图模型,并通过ROC及校准曲线分析显示,AUC为0.845(95%CI=0.795~0.896),预测PE发生的校准曲线接近理想曲线,且拟合优度HL检验χ^(2)=8.199,P=0.355。结论基于1个月内有手术或骨折史、卧床时间≥1周、存在PAH、D-D水平构建的列线图模型对AECOPD患者发生PE的预测能力较强,可为临床上该类患者的干预治疗提供参考。
Objective To explore the risk factors of pulmonary embolism(PE)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to construct a column chart model to predict PE in patients.Methods A total of 261 AECOPD patients who were treated in our hospital from May 2020 to May 2023 were collected.CT pulmonary angiography(CTPA)was performed within 24 hours of admission,and the occurrence of PE was determined based on the CTPA results and grouped into the PE group and the non PE group.General information,disease data,blood routine and biochemical indicators were collected for single factor analysis.Logistic regression was applied to analyze and screen for factors related to PE in AECOPD patients.RMS package in R software was applied to draw a column chart model for predicting the occurrence of PE in patients,the area under receiver operating characteristic(AUC)and calibration curve were applied to evaluate the discrimination and accuracy.Results 78 AECOPD patients developed PE,with an incidence rate of 29.89%,there were statistical differences in the proportions of a history of surgery or fractures within 1 month,bed rest time≥1 week,complicated pulmonary arterial hypertension(PAH),and the PaCO_(2),D-D between the PE group and the non PE group(P<0.05).Logistic regression analysis showed that the main risk factors for PE in AECOPD patients included a history of surgery or fractures within 1 month,bed rest time≥1 week,presence of PAH,and high D-D level.Based on the above four factors,a column chart model was constructed to predict the occurrence of PE,ROC and calibration curve analysis showed that the AUC was 0.845(95%CI:0.795~0.896),and the calibration curve for predicting PE occurrence was close to the ideal curve,the goodness of fit HL testχ^(2)=8.199,P=0.355.Conclusion The column chart model constructed based on a history of surgery or fractures within 1 month,bed rest time≥1 week,presence of PAH,and D-D level has strong predictive ability for PE in AECOPD patients.
出处
《浙江临床医学》
2024年第5期661-664,共4页
Zhejiang Clinical Medical Journal
关键词
慢性阻塞性肺疾病
肺栓塞
危险因素
列线图模型
Chronic obstructive pulmonary disease
Pulmonary embolism
Risk factors
Column chart model
