呼吸科低氧血症患者肺血栓栓塞症的发生及临床特征研究  

Prevalence and clinical characteristics of pulmonary thromboembolism in hospitalized patients with hypoxemia

作　　者：盛海燕[1] 金建敏[1] 刘晓芳[1] 刘涌[1] 

机构地区：[1]首都医科大学附属北京同仁医院呼吸与危重症医学科,100730

出　　处：《国际呼吸杂志》2018年第4期276-284,共9页International Journal of Respiration

摘　　要：目的观察呼吸科低氧血症患者肺血栓栓塞症（PTE）的发生率及临床特征。方法回顾性收集2009年5月至2016年5月首都医科大学附属北京同仁医院呼吸科低氧血症患者的临床资料,包括一般资料、PaO2、血浆D-二聚体水平、下肢深静脉超声、CT肺动脉造影（CTPA）及肺通气/灌注扫描等结果,分析PTE的发生率及临床特征。结果176例低氧血症患者诊断PTE73例,发生率为41.48%。176例患者中141例合并肺部基础疾病,PTE组与无PTE组的咯血、胸痛及呼吸困难等临床表现差异无统计学意义。原发性支气管肺癌、支气管哮喘、支气管扩张症、慢性阻塞性肺疾病合并PTE的发生率较高,分别为38.89%（7/18）、33.33%（7/21）、33.33%（4/12）和30.30%（10/33）。血浆D-二聚体≥1000μg/L（OR=3.070,95%CI：1.436-6.563）、深静脉血栓（DVT）（OR=3.915,95%CI：1.481-10.349）和体质量指数（BMI）≥24.00kg/m2（OR=2.760,95%CI：1.214-6.278）为低氧血症住院患者发生PTE的危险因素。将PTE患者分为D-二聚体水平正常组（28例）和D-二聚体水平升高组（45例）,亚段TE（OR=5.557,95%CI：1.508-20.482）与年龄〈70岁（OR=4.126,95%CI：1.414-12.037）是血浆D-二聚体水平正常的相关因素。依据是否存在肺部基础疾病将PTE患者分为无肺部基础疾病组（35例）和合并肺部基础疾病组（38例）。与无肺部基础疾病组相比,PTE合并肺部基础疾病组的男性比例（57.89%比31.43%）、咳嗽/咳痰症状比例（55.26%比14.29%）、发热症状比例（18.42%比2.86%）、D-二聚体≥500μg/L比例（81.58%比54.29%）以及DVT的发生率（44.74%比17.14%）较高（P值均〈0.05）,但BMI≥24kg/m2的比例（65.71%比91.30%）、卧床时间≥3d的比例（8.57%比34.29%）、晕厥发生比例（0.00%比22.86%）和PaO2数值[（61.88±10.55）mmHg比（67.06±8.04）mmHg]较低（P值均〈0.05）。结论呼吸科低氧血症患者PTE发生率较高,D-二聚体≥100Objective To observe the prevalence and clinical characteristics of pulmonary thromboembolism （PTE） in patients with hypoxemia at department of respiratory medicine. Methods The clinical data of inpatients with hypoxemia at department of respiratory medicine in Beijing Tongren Hospital from May 2009 to May 2016 were retrospectively analyzed to investigate the prevalence and clinical characteristics of PTE, which included general information, PaO2, serum level of D-dimer, deep venous ultrasonography, computer tomography pulmonary angiography （CTPA） and ventilation-perfusion scanning. Results The incidence rate of PTE in patients with hypoxemia was 41.48% （73/176）. 141 patients were found to be combined with pulmonary underlying diseases. There was no difference in clinical manifestations such as hemoptysis, chest pain and dyspnea between PTE group and non-PTE group. The incidence rate of PTE in patients with lung cancer, asthma, bronchiectasis and chronic obstructive pulmonary disease was 38.89% （7/18）, 33. 33% （7/21）, 33.33% （4/12） and 30.30% （10/ 33）, respectively. D-dimer≥ 1 000 μg/L （ OR = 3. 070, 95% CI ： 1. 436-6. 563）, deep vein thrombosis （OR =3.915,95% CI ：1.481-10.349） and body mass index≥24. 00 kg/m2（ OR =2.760, 95% CI ： 1. 214-6. 278） were found to be risk factors of PTE in patients with hypoxemia. Patients with PTE were further divided into normal group （n = 28） and abnormal group （n = 45） according to serum level of D-dimer. Logistic regression analysis showed that subsegmental PTE （OR = 5.557, 95% CI ： 1.508- 20. 482） and aged 70 years old （OR = 4. 126, 95% CI ：1. 414-12. 037） were associated with normal serum level of D-dimer. The patients were also divided into PTE without pulmonary underlying diseases （n =35） and PTE with pulmonary underlying diseases （ n = 38）. Compared with the former, the latter demonstrated increased proportion of males （57.89% vs 31.43%）, higher prevalence of symptoms including cough/expectora

关 键 词：低氧血症 肺血栓栓塞症 发生率 临床特征 危险因素 

分 类 号：R563.5[医药卫生—呼吸系统]