血液系统恶性肿瘤并发肺栓塞患者的临床分析  

Clinical analysis of hematological malignancies complicated with pulmonary embolism

作　　者：田志刚[1] 王艳[1] 朱佳荣[1] 张红[1] 杨伟 

机构地区：[1]宁夏医科大学总医院呼吸与危重症医学科,宁夏银川750004 [2]宁夏第三人民医院呼吸科,宁夏银川750011

出　　处：《宁夏医学杂志》2016年第12期1165-1167,共3页Ningxia Medical Journal

摘　　要：目的 提高对血液系统肿瘤合并肺栓塞临床特点的认识,分析血液系统肿瘤并发肺栓塞的危险因素与临床特点。方法 回顾性分析收治的22例血液系统恶性肿瘤合并肺栓塞患者（血液系统恶性肿瘤合并肺栓塞组）的临床特点,其中男9例,女13例;年龄17-77岁,平均（63.5±9.4）岁。选取同期确诊为血液系统恶性肿瘤无肺栓塞的患者（血液系统恶性肿瘤组）30例作为对照,男14例,女16例;年龄16-78岁,平均（60.9±7.8）岁。采用Logistic回归分析血液系统恶性肿瘤合并肺栓塞的危险因素。结果 22例确诊血液系统恶性肿瘤合并肺栓塞者中13例（59.1%）合并下肢深静脉血栓形成（DVT）,经CT肺动脉造影（CTPA）检查确诊21例,经核素肺通气灌注扫描（V/Q显像）确诊1例。22例患者中,6例放弃治疗,其中4例死亡;经抗凝治疗患者15例,溶栓治疗1例,治疗后显效13例、无效3例。血液系统恶性肿瘤合并肺栓塞组患者的主要临床表现为呼吸困难、咳嗽并咳痰、胸痛、心悸、晕厥、下肢不对称肿胀。血液系统恶性肿瘤合并肺栓塞组的血氧分压为（69.1±19.3）mm Hg,低于血液系统恶性肿瘤组的（81.4±13.7）mm Hg,差异有统计学意义（P〈0.05）;D-二聚体为（870.5±541.7）μg/L,高于血液系统恶性肿瘤组的（337.5±169.4）μg/L差异有统计学意义（P〈0.05）。多因素分析显示,血氧分压低于80mm Hg、D-二聚体〉500μg/L是血液系统恶性肿瘤发生肺栓塞的危险因素（OR值分别为3.15和2.09）。结论 血液系统肿瘤合并肺栓塞的临床表现复杂,病情较重,并严重影响原发疾病的治疗。对于血液系统肿瘤患者出现不明原因气短的患者要高度警惕肺栓塞发生,以便早期诊断并治疗。低氧血症及高D-二聚体是血液系统肿瘤合并肺栓塞的独立危险因素。Objective To investigate the clinical characteristics and the risk factors of pulmonary embolism（PE） with hemato- logical malignancies（HM）. Method A total of 22 HM patients complicated with PE admitted were retrospectively reviewed. There were 9 males and 13 females, with an average of （63.5 ± 9.4） years （range 17 -77 years）. 30 patients were selected as the control group, the patients were diagnosed with hematological malignancies without pulmonary embolism, including 14 males and 16 females ,with an average of （60. 9 ±7.8） years （range from 16 to 78 years）. Logistic regression analysis was used to evaluate the risk factors. Result Deep ve- nous thrombosis （DVT） occurred in 13 cases （59.1%） of PE with HC. 21 patients were diagnosed by CT pulmonary angiography（ CT- PA）, 1 patient was diagnosed by ventilation - perfusion lung scintigraphy （V/Q scintigraphy）. 6 cases gave up treatment in the HM with PE,including 4 deaths;15 cases received anticoagulant therapy, 1 case received thrombolytic therapy, 13 cases were cured or alleviated, only 3 cases were ineffective at the end. The main clinical manifestations of HM and PE patients were dyspnea, cough with sputum pro- duction, chest pain,heart palpitations, syncope and asymmetric lower limb swelling. These patients with HM and PE had a lower PaO2 （69.1 ± 19.3 ） mmHg, less than （ 82.5 ± 13.4） mmHg HM group, （ P 〈 0. 05 ）, they also showed higher D - Dimer level （ 870. 5 ± 541.7）μg/L, than the HM （344.9 ± 176.3） μg/L （P 〈 0.05 ）. Multi - factor analysis showed that PaO2 〈 80 mmHg, D - Dimer 〉 500 μg/L were the risk factors for HC and PE （ OR values were 3.15 and 2.09）. Conclusion The clinical manifestations of HM with PE patients were complicated and serious,which seriously affected the treatment of primary disease. If the HM patients fell shortness of breath which cant find any other reason, we should be alert to the occurrence of pulmonary embolism. Myeloma,hypoxemia and high D - dimer

关 键 词：血液系统恶性肿瘤 肺栓塞 危险因素 

分 类 号：R733[医药卫生—肿瘤]