慢性阻塞性肺疾病急性加重合并静脉血栓栓塞症的临床特征、危险因素及早期识别研究  

Clinical features, risk factors and early identification of acute exacerbation of chronic obstructive pulmonary disease with venous thromboembolism

作　　者：王静[1,2] 鲁月[1] 龚娟妮 李积凤[1] 王慧娟[1] 何建国[3] 杨媛华[1] WANG Jing;LU Yuel;GONG Juan-ni;LI Ji-fengl;WANG Hui-juan;HE Jian-guo;YANG Yuan-hua(Beijing Institute of Respira-tory Diseases,Beo＇ing Chaoyang Hospital Beijing Capital Medical University,Beijing 100020,China;Department of Respiratory,Bei-ring Sixth Hospital Beijing 100007,China;State key Laboratory of Cardiovascular Diseases,Fuwei Hospital Fuwei Hospital Chinese Academy of Medical Sciences,State Cardiovascular Disease Center,Peking Union Medical College,Chinese Academy of Medical Sci-ences,Bei/ing 100037,China)

机构地区：[1]首都医科大学附属北京朝阳医院北京呼吸疾病研究所,北京100020 [2]北京市第六医院呼吸科,北京100007 [3]中国医学科学院北京协和医学院国家心血管病中心中国医学科学院阜外医院心血管疾病国家重点实验室,北京100037

出　　处：《中国医刊》2018年第10期1102-1106,共5页Chinese Journal of Medicine

基　　金：重大慢性非传染性疾病防控研究重点专项(016YFC1304400)

摘　　要：目的明确慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并静脉血栓栓塞症(venous thromboembolism,VTE)的临床特征、危险因素,有助于临床早期识别及诊断。方法连续纳入首都医科大学附属北京朝阳医院及北京市第六医院呼吸科住院的AECOPD患者153例,均完善螺旋CT肺动脉造影(CT pulmonary angiography,CTPA)及下肢静脉超声检查,根据检查结果分为VTE+AECOPD组和AECOPD组,比较两组患者在发生VTE的常见危险因素、临床症状及体征、动脉血气分析、D-二聚体、B型利钠肽(B-type natriuretic peptide,BNP)、肌钙蛋白I(c TNI)、心脏彩色超声等方面的差异。结果 153例AECOPD患者中,30例(19.6%)合并VTE,123例(80.4%)未合并VTE,两组临床特征比较,在既往静脉血栓病史、制动或卧床>3天、双下肢非对称水肿、听诊肺动脉瓣第二心音亢进(P2亢进)方面差异有显著性。辅助检查方面,两组D-二聚体、c TNI升高及三尖瓣反流加快等差异有显著性。多因素logistic回归分析显示,静脉血栓病史、不对称下肢水肿及D-二聚体升高为AECOPD合并VTE的独立危险因素。应用ROC曲线计算曲线下面积(AUC)为0.757,相对应的D-二聚体最佳界值为0.505mg/L,敏感度为0.800,特异度为0.659。结论 AECOPD患者VTE的发生率为19.61%,既往静脉血栓病史、制动或卧床>3天、双下肢非对称水肿、P2亢进、c TNI升高、三尖瓣反流速度增快是AECOPD合并VTE的高危因素,而D-二聚体<0.505mg/L可作为VTE除外诊断的标准。Objective To investigate acute exacerbation of chronic obstructive pulmonary disease（AECOPD） combined Venous thromboembolism（VTE） clinical characteristics, risk factors, help clinical early recognition and diagnosis. Method A total of 153 AECOPD patients, by CTPA and lower limb venous ultrasound screening of the merger of VTE patients, and turn it into case group（AECOPD combined VTE group）, the control group（pure AECOPD group）, respectively to compare two groups of patients in the common risk factors of VTE（including age, BMI, past history of venous thrombosis, etc.）, clinical symptoms and signs, arterial blood gas analysis, D-dimer, BNP, troponin I, heart colour to exceed, such as the result of the differences between. Result Among 153 patients with AECOPD, 30（19.6%） had VTE, while 123（80.4%） had no VTE. In the previous history of venous thrombosis, immobilization time〉3 days, asymmetrical edema of both lower limbs,P2 hyperthyroidism, there was a statistically significant difference between the two groups. There were statistically significant differences in d-dimer, cTNI and tricuspid regurgitation between the two groups. Multivariate Logistic regression analysis showed that the history of venous thrombosis, asymmetrical lower limb edema, and d-dimer elevation were independent risk factors for AECOPD combined with VTE. Using ROC curve, the area（AUC） under the curve was calculated as 0.757, and the corresponding optimal boundary value of d-dimer was 0.505 mg/L, with a sensitivity of 0.800 and a specificity of 0.659. Conclusions The incidence of VTE during acute exacerbation of chronic obstructive pulmonary disease was 19.61%.Previous history of venous thrombosis, 3 days of in immobilization or bed, asymmetrical edema in both lower limbs, P2 hyperthyroidism, cTNI are high risk factors for AECOPD with VTE. And d-dimer 〈0.505 mg/L can be used as the criteria for VTE exclusion diagnosis.

关 键 词：慢性阻塞性肺疾病 静脉血栓栓塞症 危险因素 

分 类 号：R543.2[医药卫生—心血管疾病]