导管抽栓联合置管溶栓与单纯置管溶栓治疗 急性肺栓塞的疗效对比及预测模型构建

Comparison of Efficacy between Catheter Embolectomy Combined with Catheter-Directed Thrombolysis and Isolated Catheter-Directed Thrombolysis in the Treatment of Acute Pulmonary Embolism and Construction of a Predictive Model

摘要: 目的：比较导管抽栓联合置管溶栓与单纯置管溶栓治疗急性肺栓塞的疗效与安全性，构建预后预测模型。方法：双向队列纳入70例患者，分为联合组(n = 33)与单纯溶栓组(n = 37)。主要疗效为复合结局(无血流动力学失代偿及死亡)。采用多因素Logistic回归构建预测模型，ROC曲线评估预测效能，并进行亚组分析与成本效果评价。结果：联合组基线病情更重(术前肺动脉压力更高，P = 0.021)，但复合结局成功率显著更高(81.8% vs 54.1%, P < 0.05)，成本效果比更优。模型1 (临床–影像模型)显示术前肺动脉压力(OR = 0.637)与sPESI评分(OR = 0.139)为独立预测因素(P < 0.01)，两者联合预测AUC达0.886。联合治疗在sPESI 1~2分组中疗效优势显著(OR = 13.500, P = 0.018)。结论：联合治疗疗效及成本效益均优于单纯置管溶栓，术前肺动脉压力联合sPESI评分预后预测价值最优，联合治疗在sPESI 1~2分患者中优势明显。

Abstract: Objective: To compare the clinical efficacy and safety of catheter-directed thrombectomy combined with catheter-directed thrombolysis versus catheter-directed thrombolysis alone in patients with acute pulmonary embolism (APE), and to construct a prognostic prediction model. Methods: An ambidirectional cohort study enrolled 70 APE patients, divided into combination therapy group (n = 33) and thrombolysis alone group (n = 37). The primary efficacy outcome was a composite outcome (absence of hemodynamic decompensation and death). Multivariate logistic regression was used to construct prediction models. The predictive performance was assessed using ROC curves. Subgroup analysis and cost-effectiveness evaluation were also conducted. Results: The combination group had more severe baseline conditions (higher preoperative pulmonary artery pressure, P = 0.021), but achieved a significantly higher success rate of the composite outcome (81.8% vs 54.1%, P < 0.05) and a better cost-effectiveness ratio. Model 1 (clinical-imaging model) identified preoperative pulmonary artery pressure (OR = 0.637) and sPESI score (OR = 0.139) as independent predictors (P < 0.01). The combined model of these two factors achieved an AUC of 0.886. Combination therapy showed a significant efficacy advantage in the sPESI 1~2 subgroup (OR = 13.500, P = 0.018). Conclusion: The combination therapy is superior to catheter-directed thrombolysis alone in both efficacy and cost-effectiveness. The combination of preoperative pulmonary artery pressure and sPESI score provides optimal prognostic predictive value, and the advantage of combination therapy is more pronounced in patients with sPESI 1~2.