非显性因素所致慢性阻塞性肺疾病急性加重合并肺栓塞的临床特征与相关因素分析  

Pulmonary embolism in patients with chronic obstructive pulmonary disease exacerbations ofunknown origin： clinical characteristics and risk factors

作　　者：王同生[1] 毛毅敏[1] 孙瑜霞[1] 娄源杰[1] 

机构地区：[1]河南科技大学第一附属医院呼吸科,洛阳471003

出　　处：《中华结核和呼吸杂志》2012年第4期259-263,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：河南省医学科技攻关项目（200803092）

摘　　要：目的探讨非显性因素所致COPD急性加重（AECOPD）发生肺栓塞的临床特征，并研究非显性因素所致AECOPD合并肺栓塞的相关因素。方法连续纳入因非显性因素所致AECOPD患者208例，年龄50-82岁，平均（62±12）岁。入院24h内进行CT肺动脉造影及双下肢静脉彩超检查，根据造影结果分为合并肺栓组69例和无肺栓塞组139例。均检测动脉血气分析、D-二聚体和内皮素-1。正态分布的计量资料采用t检验，非正态分布资料采用Mann-Whitney“检验，计数资料构成比的比较采用）（2检验，采用logistic回归方程进行危险因素分析。结果非显性因素所致AECOPD患者合并肺栓塞者占33％（69／208）；合并肺栓塞组和无肺栓塞组卧床≥7d者分别占21．7％（15／208）和13．7％（19／208），双下肢不等粗≥1cm者分别占34．8％（24／208）和15．1％（21／208），深静脉血栓形成者分别占37．7％（26／208）和12．2％（17／208），晕厥者分别占11．6％（8／208）和0．06％（9／208），心电图表现为SIQⅢTⅢ综合征者分别占11．6％（8／208）和0．04％（5／208），PaCO：下降≥5mmHg（1mmHg=0．133kPa）者分别占27．5％（19／208）和9．3％（13／208），差异均有统计学意义（X2值为4．32～6．79，均P〈0．05）。合并肺栓塞组D-二聚体水平[（760±152）μg∥L]高于无肺栓塞组[（253±56）μg∥L]，内皮素-1的中位数（四分位间距）[5．4ng/L（1．6～6．9ng／L）]高于与无肺栓塞组[1．8ng/L（1．3-4．8）ng／L]，差异均有统计学意义（Z值分别为-2．946和-2．532，均P〈0．01）。卧床97d、双下肢不等粗≥1cm和深静脉血栓形成是COPD合并肺栓塞的危险因素（OR值为2．31～3．24，均P〈0．05）。结论非显性因素所致AECOPD患者易合并肺栓塞。卧床时间长、双下肢不等粗和深静脉血栓是合并肺栓塞的相关因素。Objective To evaluate the prevalence of pulmonary embolism （PE） in patients with chronic obstructive pulmonary disease （COPD） exacerbations of unknown origin and to explore the risk factors associated with PE. Methods A total of 208 consecutive patients with COPD were referred to this hospital for severe exacerbations of unknown origin. Their age was 50 -82 years, with a mean of （62 ± 12） years. All patients were examined within 48 h of admission by CT pulmonary angiography （CTPA） and lower extremity ultrasonography. The patients were classified as PE positive （positive results on CTPA ） or PE negative （negative results on CTPA）. Arterial blood gas, the levels of D-dimer and ET-1 were measured in all the patients. Differences between groups were analyzed using a two-tailed unpaired t test for normally distributed variables and a Mann-Whitney u test for non-normally distributed variables. Qualitative data were assessed using chi-square test, and risk factors were analyzed using logistic regression analysis. Results The frequency of PE was 33% in this series of 208 consecutive patients with COPD referred for exacerbations of unknown origin. There were differences between PE positive and PE negative groups in the following factors （X2 =4.32 -6.79, mean P 〈0.05）： immobilization t〉7 days 21.7% （15/208） vs 13.7%（19/208） ; difference in circumference of lower limbs /〉1 cm 34. 8% （24/208） vs 15. 1% （21/208） ; deep venous thrombosis （DVT） 37.7% （ 26/208 ） vs 12. 2% （ 17/208 ） ; syncope 11.6% （ 8/208 ） vs 0.06% （9/208） ; SI Qm Tm syndrome 11.6% （8/208） vs 0.04% （5/208） ; decrease in PaCO2 /〉 5 mm Hg （I mm Hg =0. 133 kPa） 27.5% （19/208） vs 9.3% （13/208）. Plasma D-dimer and ET-1 levels were significantly higher in patients with PE as compared to patients without PE. D-dimer levels were （760 ±152） μg,/L and （253 ± 56） p,g/L （ Z = - 2. 946, P 〈 0.01 ） ; ET-1 levels were 5.4 ng/L （ 1.6 - 6. 9 ng/L） and 1.8 ng/L �

关 键 词：肺疾病 慢性阻塞性 肺栓塞 内皮缩血管肽类 D-二聚体 

分 类 号：R563.5[医药卫生—呼吸系统]