肺泡动脉氧分压差对急性肺栓塞患者 远期预后的影响

Influence of alveolar-arterial oxygen gradient on prognosis of patients with acute pulmonary embolism

摘要:

目的 探讨肺泡动脉氧分压差[P（A-a）O2] 对急性肺栓塞（APE）患者远期生存状况的影响。方法 回顾 性收集2011 ～ 2016 年在唐山市3 所三甲医院首次确诊为APE 患者的病历资料，并电话随访收集患者的生存信息。 根据P（A-a）O2 与APE 患者预后的ROC 曲线，将患者分成2 组：P（A-a）O2<41.5 mmHg 组和P（A-a）O2 ≥ 41.5 mmHg 组。 采用Kaplan-Meier法绘制生存曲线，采用COX比例风险回归模型分析P（A-a）O2 水平与APE患者出院后死亡的关系。 结果 共432 例APE 患者进入分析，其中59 例发生出院后死亡。P（A-a）O2<41.5 mmHg 组和P（A-a）O2 ≥ 41.5 mmHg 组的出院后病死率分别为2.7% 和31.0%，调整其他影响因素后，P（A-a）O2 ≥ 41.5 mmHg 可提高APE 患者的出院 死亡风险[H^R=1.776（95%CI ：1.006，3.136）]。结论 P（A-a）O2 水平可以预示APE 患者的预后。

Abstract:

Objective To explore the effect of alveolar-arterial oxygen gradient [P(A-a)O2] level at the admission on the prognosis of the patients with acute pulmonary embolism (APE). Methods The medical records of the patients who were firstly confirmed APE in 3 first-class hospitals at grade 3 in Tangshan from 2011 to 2016 were retrospectively collected. The survival information of the patients was collected by telephone follow-up. According to P(A-a)O2 and the ROC curve of the prognosis of the APE patients, the patients were divided into two groups: P(A-a)O2 < 41.5 mmHg group and P(A-a)O2 ≥ 41.5 mmHg group. Kaplan-Meier curve was used to compare cumulative survival rate between the two groups. COX proportional hazards regression model was used to analyze the predictive value of alveolar-arterial oxygen gradient on the prognosis of APE patients. Results A total of 432 APE patients were included in the study, among which 59 patients died after discharge. The post-discharge mortality was 2.7% in the P(A-a)O2 <41.5 mmHg group and 31.0% in the P(A-a)O2 ≥ 41.5 mmHg group. After adjusting for other influencing factors, P(A-a)O2 ≥ 41.5 mmHg increased the risk of death [H^R = 1.776 (95% CI: 1.006, 3.136)]. Conclusions P(A-a)O2 can be used to predict the prognosis of the patients with APE.