肺结核合并肺栓塞患者实验室指标的诊断价值

doi:10.3969/j.issn.1004-583X.2024.02.007

摘要/Abstract

摘要：

目的探讨肺结核合并肺栓塞患者实验室指标的诊断价值,为提示肺结核患者发生肺栓塞提供依据。方法选择2019年1月至2021年12月我院确诊为肺结核合并肺栓塞的住院患者60例为观察组,按1∶1的比例选取确诊为单纯肺结核住院患者60例为对照组,观察2组一般资料和相关实验室数据的差异,采用二元logistic回归分析其危险因素并对有意义的指标绘制受试者工作曲线,评估其诊断价值。结果观察组炎症指标:白细胞、中性粒细胞、C反应蛋白、降钙素原均高于对照组(P<0.05);生化相关指标:观察组D-二聚体、纤维蛋白原、肌钙蛋白I、肌红蛋白、N末端B型脑钠肽前体也高于对照组(P<0.05);观察组淋巴细胞、白蛋白、高密度脂蛋白胆固醇、氧分压、抗凝血酶Ⅲ均低于对照组,差异有统计学意义(P<0.05)。在二元logistic回归分析中,D-二聚体、抗凝血酶Ⅲ、N末端B型脑钠肽前体是肺结核合并肺栓塞的危险因素(OR=1.302、0.957、1.012);D-二聚体曲线下面积为0.858,抗凝血酶Ⅲ曲线下面积为0.711,N末端B型脑钠肽前体曲线下面积为0.831。结论 D-二聚体>1.29 mg/L、抗凝血酶Ⅲ<101.6%、N末端B型脑钠肽前体>99.79 ng/L时,对肺结核患者发生肺栓塞有一定的预测价值,可以作为预测肺结核合并肺栓塞和评估患者预后的重要指标。

关键词: 结核, 肺, 肺栓塞, D-二聚体, 抗凝血酶Ⅲ

Abstract:

Objective To investigate the diagnostic value of laboratory indicators in patients with pulmonary tuberculosis (PTB) complicated by pulmonary embolism (PE), and to provide evidence for the patients. Methods Sixty inpatients with PTB and PE in our hospital from January 2019 to December 2021 were selected as the observation group. In addition, 60 patients with simple PTB matched according to 1∶1 ratio were selected as the control group. The differences in general information and related laboratory data between the two groups were observed. Binary logistic regression was used to analyze the risk factors, and the receiver operating characteristic (ROC) curve was drawn for meaningful indicators to evaluate their diagnostic value. Results The levels of white blood cells, neutrophils, C-reactive protein and procalcitonin in the observation group were significantly higher than those of the control group (P<0.05). Biochemical indicators including D-dimer, fibrinogen, troponin I, myoglobin, N-terminal pro-brain natriuretic peptide (NT-proBNP) in the observation group were significantly higher than those in the control group (P<0.05). The lymphocyte, albumin, high density lipoprotein cholesterol, oxygen partial pressure and antithrombin Ⅲ in the observation group were significantly lower than those of the control group (P<0.05). The results from binary logistic regression analysis showed that D-dimer, antithrombin Ⅲ and NT-proBNP were risk factors for PTB with PE (OR=1.302, 0.957, 1.012). The area under the curve (AUC) of D-dimer, antithrombin Ⅲ and NT-proBNP was 0.858, 0.711 and 0.831, respectively. Conclusion D-dimer>1.29 mg/L, antithrombin Ⅲ<101.6%, NT-proBNP >99.79 ng/L have certain predictive value for PE in patients with PTB, which can be used as an important index to predict PE and evaluate the prognosis of patients with PTB.

Key words: tuberculosis, pulmonary, pulmonary embolism, d-dimer, antithrombin Ⅲ

中图分类号:

R521

刘蕾, 李明武, 万荣. 肺结核合并肺栓塞患者实验室指标的诊断价值[J]. 临床荟萃, 2024, 39(2): 134-139.

Liu Lei, Li Mingwu, Wan Rong. Diagnostic value of laboratory indexes in patients with pulmonary tuberculosis complicated by pulmonary embolism[J]. Clinical Focus, 2024, 39(2): 134-139.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.02.007

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I2/134

图/表 8

参考文献 28

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组别	例数	性别 (男/女)	年龄 (岁)	病原学阳性 [例(%)]	合并COPD [例(%)]	合并高血压 [例(%)]	合并呼吸衰竭 [例(%)]	合并糖尿病 [例(%)]
观察组	60	(32/28)	60.00(52.00,66.00)	37(61.7)	19(31.7)	5(8.3)	7(11.7)	2(3.3)
对照组	60	(41/19)	64.50(51.50,72.00)	27(45.0)	14(23.3)	2(3.3)	3(5.0)	3(5.0)
Z/χ²值		3.104	-1.816	2.715	0.935	0.572	0.928	0.227
P值		0.078	0.069	0.099	0.333	0.449	0.335	0.634

组别	例数	性别 (男/女)	年龄 (岁)	病原学阳性 [例(%)]	合并COPD [例(%)]	合并高血压 [例(%)]	合并呼吸衰竭 [例(%)]	合并糖尿病 [例(%)]
观察组	60	(32/28)	60.00(52.00,66.00)	37(61.7)	19(31.7)	5(8.3)	7(11.7)	2(3.3)
对照组	60	(41/19)	64.50(51.50,72.00)	27(45.0)	14(23.3)	2(3.3)	3(5.0)	3(5.0)
Z/χ²值		3.104	-1.816	2.715	0.935	0.572	0.928	0.227
P值		0.078	0.069	0.099	0.333	0.449	0.335	0.634

组别	例数	WBC (×10⁹/L)	LY (×10⁹/L)	NE (×10⁹/L)	RBC (×10¹²/L)	Hb (g/L)	PLT (×10⁹/L)	白蛋白 (g/L)	球蛋白 (g/L)
观察组	60	7.11(5.15,10.33)	0.83(0.56,1.38)	5.14(3.78,8.57)	4.14±0.62	125.10±21.58	225.00(158.25,341.00)	29.90(26.20,33.40)	29.40(25.30,35.80)
对照组	60	5.66(4.52,7.21)	1.48(1.14,1.92)	3.35(2.47,4.89)	4.38±0.81	132.59±19.51	224.00(184.00,324.00)	35.70(28.03,38.10)	29.70(26.40,36.83)
Z/t值		-2.648	-4.735	-3.897	1.832	0.823	-0.770	-4.927	-1.325
P值		0.008	<0.01	<0.01	0.070	0.052	0.441	<0.01	0.185

组别	例数	WBC (×10⁹/L)	LY (×10⁹/L)	NE (×10⁹/L)	RBC (×10¹²/L)	Hb (g/L)	PLT (×10⁹/L)	白蛋白 (g/L)	球蛋白 (g/L)
观察组	60	7.11(5.15,10.33)	0.83(0.56,1.38)	5.14(3.78,8.57)	4.14±0.62	125.10±21.58	225.00(158.25,341.00)	29.90(26.20,33.40)	29.40(25.30,35.80)
对照组	60	5.66(4.52,7.21)	1.48(1.14,1.92)	3.35(2.47,4.89)	4.38±0.81	132.59±19.51	224.00(184.00,324.00)	35.70(28.03,38.10)	29.70(26.40,36.83)
Z/t值		-2.648	-4.735	-3.897	1.832	0.823	-0.770	-4.927	-1.325
P值		0.008	<0.01	<0.01	0.070	0.052	0.441	<0.01	0.185

组别	例数	HDL-C(mmol/L)	LDL(mmol/L)	PaO₂(mmHg)	PaCO₂(mmHg)
观察组	60	0.70(0.54,0.94)	2.42±0.92	66.00(57.00,86.50)	36.00(32.00,41.25)
对照组	60	1.06(0.86,1.30)	2.56±0.83	93.00(89.00,95.00)	35.00(28.33,39.00)
Z/t值		-4.252	0.705	-4.696	-0.629
P值		<0.01	0.482	<0.01	0.529