作者：庞宏刚，孟燕

单位：

西安交通大学第一附属医院周围血管科

Units：

Department of Peripheral Vascular, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China

关键词：

肺栓塞; 电解质; 病人病情; 预后;

Keywords：

Pulmonary embolism; Electrolytes; Patient acuity; Prognosis

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.092

Funds：

摘要：

目的 分析血清电解质对肺栓塞患者病情严重程度及预后的影响。方法 前瞻性选取2020年1月至2022年5月在西安交通大学第一附属医院就诊的192例肺栓塞患者作为研究对象。根据肺栓塞病情严重程度将所有患者分为低危组（n=116）、中危组（n=55）、高危组（n=21）；根据随访结果将所有患者分为存活组（n=181）和死亡组（n=11）。比较不同病情严重程度患者一般资料和实验室检查指标，不同预后患者一般资料、治疗情况及实验室检查指标。血清钠、钙及血浆D-二聚体（D-D）与肺栓塞患者病情严重程度的相关性分析采用Kendall’stau-b相关分析，与肺栓塞患者预后的相关性分析采用点二列相关分析；肺栓塞患者病情严重程度的影响因素分析采用有序Logistic回归分析，肺栓塞患者预后的影响因素分析采用多元Cox回归分析。结果 192例肺栓塞患者中低危116例（占60.4%）、中危55例（占28.6%）、高危21例（占10.9%）；随访30 d，死亡11例，死亡率为5.7%。低危组、中危组、高危组患者血清钠、钙及血浆D-D比较，差异有统计学意义（P<0.05）。Kendall’stau-b相关分析结果显示，血清钠、钙与肺栓塞患者病情严重程度呈负相关（r值分别为-0.401、-0.276,P值均<0.001），血浆D-D与肺栓塞患者病情严重程度呈正相关（r=0.487,P<0.001）。有序Logistic回归分析结果显示，血清钠、钙升高的肺栓塞患者病情严重程度较轻，血浆D-D升高的肺栓塞患者病情严重程度较重（P<0.05）。死亡组患者病情严重程度重于存活组，血清钠、钙低于存活组，血浆D-D高于存活组（P<0.05）。点二列相关分析结果显示，血清钠、钙与肺栓塞患者预后呈负相关（r值分别为-0.293、-0.318,P值均<0.001），血浆D-D与肺栓塞患者预后呈正相关（r=0.319,P<0.05）。多元Cox回归分析结果显示，病情严重程度为中高危、血浆D-D升高是肺栓塞患者死亡的危险因素，血清钠、钙升高是肺栓塞患者死亡的保护因素（P<0.05）。结论 血清钠、钙与肺栓塞患者病情严重程度、预后呈负相关，血清钠、钙升高的肺栓塞患者病情严重程度较轻，血清钠、钙升高是肺栓塞患者死亡的保护因素。

Abstract：

Objective To analyze the effect of serum electrolytes on the disease severity and prognosis of patientswith pulmonary embolism. Methods A total of 192 patients with pulmonary embolism who were admitted to the First AffiliatedHospital of Xi'an Jiaotong University from January 2020 to May 2022 were prospectively selected as the study subjects. Accordingto the disease severity of pulmonary embolism, all patients were divided into low-risk group (n=116) , medium-risk group(n=55) and high-risk group (n=21) . According to the follow-up results, all patients were divided into survival group (n=181) anddeath group (n=11) . The general data and laboratory examination indexes were compared in patients with different severity ofdisease, the general data, treatment and laboratory examination indexes were compared in patients with different prognosis. Therelationship between serum sodium, serum calcium, plasma D-dimer (D-D) and the disease severity of pulmonary embolism wasanalyzed by Kendall'stau-b correlation analysis, and the relationship between serum sodium, serum calcium, plasma D-D and theprognosis of patients with pulmonary embolism was analyzed by point two column correlation analysis. The influencing factors ofthe disease severity of patients with pulmonary embolism were analyzed by ordinal Logistic regression analysis, and the influencingfactors of the prognosis of patients with pulmonary embolism were analyzed by multivariate Cox regression analysis. ResultsAmong 192 patients with pulmonary embolism, 116 cases (60.4%) were low-risk, 55 cases (28.6%) were medium-risk, and 21cases (10.9%) were high-risk. After 30 days of follow-up, 11 patients died, and the mortality rate was 5.7%. There were significant differences in serum sodium, serum calcium and plasma D-D among low-risk group, medium-risk group and high-risk group(P < 0.05) . The results of Kendall'stau-b correlation analysis showed that serum sodium and calcium were negatively correlatedwith the disease severity of pulmonary embolism (r values were -0.401, -0.276 respectively, both P values were < 0.001) ,and plasma D-D was positively correlated with the disease severity of pulmonary embolism (r=0.487, P < 0.001) . The resultsof ordered Logistic regression analysis showed that, the disease severity of pulmonary embolism in patients with elevated serumsodium and calcium was mild, and the severity of pulmonary embolism in patients with elevated plasma D-D was severe (P <0.05) . The severity of disease in the death group was more serious than that in the survival group, serum sodium and calcium werelower than those in the survival group, and plasma D-D was higher than that in the survival group (P < 0.05) . Point two columncorrelation analysis showed that serum sodium and serum calcium were negatively correlated with the prognosis of patients withpulmonary embolism (r values was -0.293, -0.318 respectively, both P values were < 0.001) , and plasma D-D was positivelycorrelated with the prognosis of patients with pulmonary embolism (r=0.319, P < 0.05) . Multivariate Cox regression analysisresults showed that the medium and high risk of disease, and elevated plasma D-D were risk factors for death in patients withpulmonary embolism, elevated serum sodium and calcium were protective factors for death in patients with pulmonary embolism(P < 0.05) . Conclusion Serum sodium and calcium are negatively correlated with the disease severity and prognosis of patientswith pulmonary embolism. The disease severity of pulmonary embolism is lighter in patients with elevated serum sodium andcalcium. Elevated serum sodium and calcium are protective factors for death in patients with pulmonary embolism

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