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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (04) : 586 -592. doi: 10.3877/cma.j.issn.1674-6902.2026.04.009

论著

PIV、PLR联合D-二聚体及肌钙蛋白I对123例急性肺栓塞危险分层的回顾性研究
王金强1, 王妮妮2, 陈荣荣2, 张诚实2, 张青2, 冯契靓2, 刘明2, 程联云2, 赵云峰2, 雷撼2,†(), 秦二云2,†()   
  1. 1314500　桐乡，浙江省桐乡市中医医院呼吸科
    2200125　上海，上海市浦东新区浦南医院呼吸科
  • 收稿日期:2026-03-16 出版日期:2026-08-25
  • 通信作者: 雷撼, 秦二云
  • 基金资助:
    上海市浦东新区卫生系统优秀青年医学人才培养计划(PWRq2024-33); 上海市浦东新区高峰高原学科临床医学新质专科建设资助(2025-PWXZ-06)

Retrospective study of PIV, PLR combined with D-Dimer and cardiac troponin I in risk stratification of 123 cases with acute pulmonary embolism

Jinqiang Wang1, Nini Wang2, Rongrong Chen2, Chengshi Zhang2, Qing Zhang2, Qiliang Feng2, Ming Liu2, Lianyun Cheng2, Yunfeng Zhao2, Han Lei2,†(), Eryun Qin2,†()   

  1. 1Department of Respiratory Medicine, Tongxiang Hospital of Traditional Chinese Medicine, Tongxiang 314500, China
    2Department of Respiratory Medicine, Punan Hospital, Pudong New Area, Shanghai 200125, China
  • Received:2026-03-16 Published:2026-08-25
  • Corresponding author: Han Lei, Eryun Qin
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引用本文：

王金强, 王妮妮, 陈荣荣, 张诚实, 张青, 冯契靓, 刘明, 程联云, 赵云峰, 雷撼, 秦二云. PIV、PLR联合D-二聚体及肌钙蛋白I对123例急性肺栓塞危险分层的回顾性研究[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(04): 586-592.

Jinqiang Wang, Nini Wang, Rongrong Chen, Chengshi Zhang, Qing Zhang, Qiliang Feng, Ming Liu, Lianyun Cheng, Yunfeng Zhao, Han Lei, Eryun Qin. Retrospective study of PIV, PLR combined with D-Dimer and cardiac troponin I in risk stratification of 123 cases with acute pulmonary embolism[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(04): 586-592.

目的

分析泛免疫炎症值(pan-immune-inflammation value, PIV)、血小板与淋巴细胞比值(platelet-to-lymphocyte Ratio, PLR)联合D-二聚体(d-dimer, D-D)及肌钙蛋白I(cardiac troponinc, cTnI)及其联合指标对急性肺栓塞(acute pulmonary embolism, APE)危险分层的相关性。

方法

收集2021年1月至2025年10月浙江省桐乡市中医医院、上海市浦东新区浦南医院收治的123例APE患者为对象，根据肺栓塞严重指数(pulmonary embolism severity index, PESI)评分将其分为低危组39例，中高危组84例。判断影响APE危险分层的因素，采用ROC曲线分析，以曲线下面积(area under curve, AUC)为核心评价指标，结合敏感度、特异度、约登指数及对应的截断值，分析PIV、PLR、D-D、cTnI及联合指标对APE严重程度的预测价值。

结果

中高危组NEUT 5.31( (3.95, 7.95)×109/L、MONO 0.64 (0.47, 0.81)×109/L、PIV 565.55 (373.41, 1 030.36)、D-D 7.62 (4.08, 15.18)mg/L、cTnI 20.52 (8.29, 36.91)ng/ml、SII 992.30 (696.69, 1 828.96)、NLR 4.46 (3.10, 9.44)、PLR 181.56 (131.90, 281.31)高于低危组4.46 (3.12, 5.91)×109/L、0.44 (0.35, 0.51)×109/L、171.77 (127.51, 333.45)、4.31 (1.54, 6.89)mg/L、5.35 (2.88, 11.94)ng/ml、494.21 (295.97, 840.78)、2.67 (1.66, 4.39)、109.03 (91.24, 144.61)；中高危组LYM 1.14 (0.76, 1.38)低于低危组1.84 (1.27, 2.12)，组间差异有统计学意义(P<0.05)。多因素二元Logistic回归分析结果显示，高水平的PIV、PLR、D-D、cTnI易发生中高危APE。PIV、PLR、D-D、cTnI预测中高危肺栓塞的AUC分别为0.827(95%CI：0.743~0.911)、0.769(95%CI：0.681~0.857)、0.694(95%CI：0.598~0.790)、0.735(95%CI：0.634~0.835)，而由上述构成的联合指标，其AUC达0.884(95%CI：0.817~0.951)，以0.560为最优截断值时，敏感度为89.29%，特异度为74.26%，约登指数为0.636。

结论

PIV、PLR、D-D、cTnI是中高危APE发生的影响因素(P<0.05)，PIV、PLR联合D-D及cTnI水平升高与APE的危险分层密切相关，联合检测可有效提高中高危APE的早期识别能力，有助于临床评估。

关键词: 急性肺栓塞, 疾病严重程度, D-二聚体, 肌钙蛋白I, 泛免疫炎症值, 系统免疫炎症指数, 血小板与淋巴细胞比值, 中性粒细胞计数与淋巴细胞计数比值
Objective

To investigate the correlation of pan-immune-inflammation value (PIV), platelet-to-lymphocyte ratio (PLR), D-dimer (D-D) and cardiac troponin I (cTnI), as well as their combined index, with the risk stratification of acute pulmonary embolism (APE).

Methods

A total of 123 APE patients admitted to Tongxiang Hospital of Traditional Chinese Medicine (Zhejiang Province) and Punan Hospital of Pudong New Area (Shanghai) from January 2021 to October 2025 were enrolled. According to pulmonary embolism severity index (PESI) scores, patients were divided into low-risk group (39 cases) and intermediate-high-risk group (84 cases). The influencing factors of APE risk stratification were analyzed, and the predictive value of single and combined indicators for APE severity was evaluated.

Results

The neutrophil count in the intermediate-high risk group was 5.31(3.95, 7.95)×109/L, monocyte count 0.64(0.47, 0.81)×109/L, PIV 565.55 (373.41, 1030.36), D-dimer 7.62(4.08, 15.18)mg/L, cTnI 20.52(8.29, 36.91)ng/ml, SII 992.30(696.69, 1 828.96), NLR 4.46(3.10, 9.44), and PLR 181.56(131.90, 281.31), which were higher than those in the low-risk group [4.46 (3.12, 5.91)×109/L, 0.44 (0.35, 0.51)×109/L, 171.77(127.51, 333.45), 4.31(1.54, 6.89)mg/L, 5.35(2.88, 11.94)ng/ml, 494.21 (295.97, 840.78), 2.67(1.66, 4.39), and 109.03(91.24, 144.61), respectively]; while the lymphocyte count in the intermediate-high risk group was 1.14(0.76, 1.38), lower than that in the low-risk group [1.84 (1.27, 2.12)], and the differences between groups were statistically significant (P<0.05). Multivariate binary Logistic regression analysis confirmed that high levels of PIV, PLR, D-D and cTnI were independent risk factors for intermediate-high-risk APE. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of PIV, PLR, D-D and cTnI for predicting intermediate-high-risk APE was 0.827 (95%CI: 0.743~0.911), 0.769(95%CI: 0.681~0.857), 0.694 (95%CI: 0.598~0.790) and 0.735 (95%CI: 0.634~0.835), respectively, while the combined index had an AUC of 0.884 (95%CI: 0.817~0.951). At the optimal cut-off value of 0.560, the sensitivity, specificity and Youden index were 89.29%, 74.26% and 0.636, respectively.

Conclusion

PIV, PLR, D-D and cTnI are influencing factors for the occurrence of intermediate-high risk pulmonary embolism. Elevated levels of PIV, PLR combined with D-D and cTnI are closely correlated with the risk stratification of APE. Combined detection can effectively improve the early identification ability of intermediate-high risk APE and facilitate clinical evaluation.

Key words: Acute pulmonary embolism, Disease severity, D-dimer, Troponin I, Pan-immune-inflammation Value, Systemic immune-inflammation index, Platelet-to-lymphocyte ratio, Neutrophil-to-lymphocyte ratio
表1 两组急性肺栓塞患者基线资料的比较
临床资料 低危组(n＝39) 中高危组(n＝84) 统计值 P值
BMI[kg/m2，(±s)] 24.68±2.96 23.52±3.86 t＝1.836 0.069
收缩压[mmHg，(±s)] 127.87±16.87 127.90±20.63 t＝－0.009 0.993
舒张压[mmHg，(±s)] 78.67±10.95 75.26±12.33 t＝1.475 0.143
WBC(×109/L) 6.90(5.80, 8.28) 7.69(5.63, 10.17) Z＝－1.576 0.115
PLT(×109/L) 181.00(156.50，214.50) 202.00(161.00，266.25) Z＝－1.726 0.084
NEUT(×109/L) 4.46(3.12, 5.91) 5.31(3.95, 7.95) Z＝－2.408 0.016
MONO(×109/L) 0.44(0.35, 0.51) 0.64(0.47, 0.81) Z＝－4.197 0.000
LYM(×109/L) 1.84(1.27, 2.12) 1.14(0.76, 1.38) Z＝－4.278 0.000
PIV 171.77(127.51，333.45) 565.55(373.41，1 030.36) Z＝－5.818 0.000
D-D(mg/L) 4.31(1.54, 6.89) 7.62(4.08, 15.18) Z＝－3.457 0.000
cTnI(ng/ml) 5.35(2.88, 11.94) 20.52(8.29, 36.91) Z＝－4.177 0.000
SII 494.21(295.97，840.78) 992.30(696.69，1 828.96) Z＝－4.465 0.000
NLR 2.67(1.66, 4.39) 4.46(3.10, 9.44) Z＝－4.019 0.000
PLR 109.03(91.24，144.61) 181.56(131.90，281.31) Z＝－4.786 0.000
BNP(pg/ml) 51.24(24.08，100.32) 81.33(32.44，170.40) Z＝－1.848 0.065
CRP(mg/L) 4.50(1.11, 19.89) 10.00(4.59, 39.04) Z＝－1.848 0.065
PaO2(mmHg) 88.60(74.90，102.15) 78.85(64.75，100.30) Z＝－1.239 0.215
图1 典型病例的CTPA图像。图A、B为不同患者及不同栓塞部位图像注：蓝色箭头指示肺动脉内栓塞位置
表2 影响急性肺栓塞患者风险分层的多因素Logistic回归分析
变　量 β S.E Z值 P值 OR(95%CI)
D-D 0.223 0.060 3.710 <0.001 1.250(1.111~1.406)
cTnI 0.034 0.013 2.586 0.010 1.035(1.008~1.062)
PIV 0.003 0.001 2.531 0.011 1.003(1.001~1.005)
SII 0.000 0.001 0.227 0.821 1.000(0.998~1.003)
NLR －0.241 0.158 －1.524 0.127 0.786(0.577~1.071)
PLR 0.014 0.007 2.032 0.042 1.014(1.001~1.027)
常量 －4.288 1.031 －4.161 <0.001 0.014(0.002~0.104)
图2 单项及联合指标评估APE风险分层的ROC曲线注：D-D为D-二聚体；cTnI为肌钙蛋白I；PIV为中性粒细胞计数×血小板计数×单核细胞计数/淋巴细胞计数；PLR为血小板计数与淋巴细胞计数比值
表3 PIV、PLR、D-D、cTnI及联合指标对中高危APE的预测结果
变　量 AUC 95%CI 截断值 敏感度(%) 特异度(%) 约登指数 P值
D-D 0.694 0.598~0.790 7.36 53.57 79.49 0.331 0.000
cTnI 0.735 0.634~0.835 7.33 80.95 69.25 0.502 0.000
PLR 0.769 0.681~0.857 125.62 80.95 66.67 0.476 0.000
PIV 0.827 0.743~0.911 281.29 85.71 71.79 0.575 0.000
联合指标 0.884 0.817~0.951 0.560 89.29 74.26 0.636 0.000
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