肺栓塞抗凝治疗后残余血栓的危险因素分析  

Risk factors of residual thrombi after anticoagulant therapy for acute pulmonary embolism

作　　者：隋婧婧 王丽君[1] 邵艳梅[1] 程兆忠[1] 

机构地区：[1]青岛大学附属医院崂山院区呼吸科,山东青岛266000

出　　处：《中华实用诊断与治疗杂志》2016年第7期678-680,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：北京(市)国家"十二五"科技支撑计划项目(2011BAI11B17)

摘　　要：目的 探讨急性肺栓塞（acute pulmonary embolism,APE）抗凝治疗后残余血栓形成的危险因素。方法 回顾性分析129例经抗凝治疗3个月以上的APE患者的临床资料,根据治疗后CT肺动脉造影结果分为血栓完全溶解组85例和残余血栓组44例,比较2组临床资料,分析残余血栓形成的独立危险因素。结果 残余血栓组急性期纤维蛋白原水平[（4.01±1.12）g/L]、无明显诱因比例（93.2%）、右心室扩大发生率（38.6%）、中央型栓塞发生率（50.0%）、确诊时主肺动脉与主动脉直径比值〉1发生率（45.5%）均高于完全溶解组[（3.43±0.93）g/L、77.6%、14.1%、27.1%、24.7%]（P〈0.05）;多因素logistic回归分析显示,无明显诱发因素（OR=0.231,95%CI：0.062~0.861,P=0.029）、急性期纤维蛋白原水平升高（OR=1.958,95%CI：1.282~2.991,P=0.001）、右心室扩大（OR=5.696,95%CI：2.085~15.561,P=0.002）是残余血栓发生的独立危险因素。结论 部分APE患者经抗凝治疗后血栓不能完全溶解,无明显诱发因素、急性期纤维蛋白原水平、右心室扩大是残余血栓的独立危险因素。Objective To investigate the risk factors of residual thrombi after anticoagulant therapy for acute pulmonary embolism （APE）. Methods The clinical data of 129 patients with APE were retrospectively analyzed after anticoagulant therapy for over 3 months. The patients were divided into complete thrombolysis group （n=85） and residual thrombi group （n = 44） according to the CT pulmonary angiographic results. The clinical data were compared to analyze the independent risk factors of residual thrombi. Results The level of fibrinogen in acute phase （（4.01 =.12） g/L）, the rate of unprovoked APE （93. 2~）, the incidence of enlarged right ventricular （38. 6~）, the incidence of central embolism （50.0 ~ ） and the incidence of main pulmonary artery to aortic diameter ratio 〉 1 （45.5 ~ ） in residual thrombi group were significantly higher than those in complete thrombolysis group （（3. 43 ±0. 93） g/L, 77. 6%, 14. 1%, 27.1%0, 24. 7%） （P〈0.05）. Multivariable logistic regression analysis revealed that the independent risk factors for residual thrombi included unprovoked APE （OR=0. 231, 95%CI： 0. 062 to 0. 861, P：0. 029）, fibrinogen in acute phase （OR=. 958, 95%I： 1. 282 to 2. 991, P=0. 001）, and enlarged right ventricle （OR=5. 696, 95%CI： 2. 085 to 15. 1561, P=0. 002）. Conclusion Pulmonary thrombi in some patients with APE can not be completely resolved after anticoagulant therapy. Unprovoked APE, fibrinogen in acute phase and enlarged right ventricle are the independent risk factors for residual thrombi.

关 键 词：肺栓塞 残余血栓 危险因素 

分 类 号：R563.5[医药卫生—呼吸系统]