2024 年第 8 期 第 0 卷

肺栓塞患者国际标准化比值不稳定的危险因素研究

Study on the risk factors of international normalized ratio instability in patients with pulmonary embolism

作者：田春营1高娜2许铭缨1李娅静1王喜福1

英文作者：Tian Chunying1 Gao Na2 Xu Mingying1 Li Yajing1 Wang Xifu1

单位：1首都医科大学附属北京安贞医院急诊危重症中心，北京100029；2首都医科大学附属北京安贞医院风湿免疫科，北京100029

英文单位：1Emergency Intense Care Unit Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Rheumatology and Immunology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：肺栓塞；国际标准化比值；危险因素

英文关键词：Pulmonaryembolism;Internationalnormalizedratio;Riskfactors

• 摘要：

• 目的 分析肺栓塞患者国际标准化比值（INR）不稳定的危险因素并依此构建预测模型并进行验证。方法 回顾性选取2017年1月至2022年8月于首都医科大学附属北京安贞医院就诊的肺栓塞患者562例，将患者分为INR不稳定组（47例）和INR稳定组（515例）。比较2组患者临床资料。采用Logistic回归方法分析肺栓塞患者INR不稳定的影响因素，采用受试者工作特征(ROC)曲线进行验证。结果 2组性别比例、体重指数、总胆红素水平及活动期肿瘤、感染、心力衰竭、下肢肿胀、风湿性心脏病、高血压病、贫血比例比较,差异均有统计学意义(均P<0.05)。Logistic回归分析结果显示男性（比值比=2.94，95%置信区间：1.41~6.13，P＜0.01）、风湿性心脏病（比值比=17.70，95%置信区间：2.78~112.64，P＜0.01）、贫血（比值比=7.76，95%置信区间：3.37~17.87，P＜0.01）是肺栓塞患者INR不稳定的危险因素。ROC曲线分析结果显示男性、风湿性心脏病及贫血三项联合预测INR不稳定的曲线下面积为0.787。结论 性别、风湿性心脏病及贫血是肺栓塞患者INR不稳定的独立影响因素，三项联合预测INR不稳定优于单一指标预测，具有良好的参考价值。

• Objective To analyze the relevant factors affecting the instability of international normalized ratio (INR) in patients with pulmonary embolism, and to construct a nomogram prediction model and verify it. MethodA retrospective analysis was performed on 562 patients with pulmonary embolism admitted to Beijing Anzhen Hospital, Capital Medical University from January 2017 to August 2022. Patients were divided into INR instability group (47 cases) and INR stability group (515 cases). The clinical data of the two groups were compared. The influencing factors of INR instability in patients with pulmonary embolism were analyzed by Logistic regression method and verified by receiver operating characteristic (ROC) curve. Results  There were significant differences in gender ratio, body mass index, total bilirubin level and the proportions of active tumor, infection, heart failure, lower limb swelling, rheumatic heart disease, hypertension and anemia between the two groups (all P<0.05). Logistic regression analysis showed that male (odds ratio=2.94, 95% confidence interval: 1.41-6.13, P<0.01), rheumatic heart disease (odds ratio=17.70, 95% confidence interval: 2.78-112.64, P<0.01), anemia (odds ratio=7.76, 95% confidence interval: 3.37-17.87, P<0.01) were risk factors for INR instability in patients with pulmonary embolism. ROC curve analysis showed that the area under the curve of male, rheumatic heart disease and anemia to predict INR instability was 0.787. Conclusions  Gender, rheumatic heart disease and anemia are independently correlated with INR instability in patients with pulmonary embolism, and the combined prediction of INR instability is better than that of a single index, which is a good reference value for medical staff in clinical practice.