超重及肥胖肺栓塞患者临床特征及预后分析  

Clinical characteristics and prognosis of overweight and obese patients with pulmonary thromboembolism

作　　者：乔力松[1] 许小毛[1] 杨鹤[1] 方保民[1] 谭政[1] Qiao Lisong;Xu Xiaomao;Yang He;Fang Baomin;Tan Zheng.(Division of Respiratory and Critial Care Medicine,Beijing Hospital,National Center of Gerontology,National Center of Respiratory Disease,Beijiing 100730,China)

机构地区：[1]北京医院呼吸与危重症医学科国家老年医学中心国家呼吸疾病临床研究中心,100730

出　　处：《中华结核和呼吸杂志》2018年第11期863-867,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家重点研发计划（2016YFC0905602）;国家科技支撑计划（2011BAI11B17）

摘　　要：目的观察超重及肥胖的肺栓塞患者的临床特征及预后。方法回顾性分析2009年1月至2017年12月北京医院372例肺栓塞患者的临床资料，根据体重指数分为正常体重组159例，其中男70例，女89例，年龄23-93岁，平均（69-14）岁；超重组143例，其中男70例，女73例，年龄17-89岁，平均（67±12）岁；肥胖组70例，其中男35例，女35例，年龄26-93岁，平均（66-15）岁。分析比较三组间临床特点和预后差异。结果三组患者性别、年龄、吸烟比例及基础疾病之间差异无统计学意义（均P〉0．05）。肥胖组胸痛的发生率显著低于超重组（P〈0．05），而下肢肿胀的发生率显著高于正常体重组和超重组（均P〈0．05）。肥胖组血红蛋白及红细胞压积水平显著高于正常体重组和超重组（均P〈0．05），而血清尿酸水平显著高于正常体重组（P〈0．05）。超重组采用抗凝治疗的比例显著高于正常体重组（P〈0．05），超重组和肥胖组应用华法林抗凝治疗的比例显著高于正常体重组（均P〈0．05）。超重和肥胖组住院病死率显著低于正常体重组（均P〈0．01）。多因素logistic回归分析显示，调整了年龄和性别后，恶性肿瘤（OR=3．716，95％CI：1．733-7．972，P=0．001）和高危PTE（OR值为13．815，95％CI：4．093-46．624，P〈0．001）是PTE死亡的预测因素，而抗凝治疗（OR值为0．155，95％CI：0．056。0．428，P〈0．001）、体重指数324kg／m^2（DR值为0．142，95％CI：0．045-0．446，P=0．001）、体重指数328kg／m^2（OR值为0．272，95％CI：0．085-0．872，P=0．029）是生存的预测因素。结论超重及肥胖的PTE患者高血压、糖尿病、冠心病、高脂血症等合并症比例与正常体重者无明显差异，肥胖患者尿酸及血红蛋白水平高于正常体重者，超重及肥胖的肺栓塞患者预后较好。Objective To investigate the clinical characteristics and outcomes of overweight and obese patients with pulmonary embolism. Methods This was a retrospective study of patients with pulmonary thromboembolism（PTE） in Beijing Hospital between 2009 and 2017. Data were analyzed and compared based on body mass index （BMI）, and patients were classified into normal weight, overweight, and obese. Results Among 372 patients with PTE, 159 were normal, 143 were overweight and 70 were obese. The mean age was （67.8±13.4） years, and 159（47.0%） were males. There was no significant difference in age, sex, smoking ratio, and underlying disease between the 3 groups （all P〉0.05）. Chest pain was less frequent in the obese group than the overweight group （P〈0.05）, and swollen of lower limbs was more prevalent in the obese group than the first 2 groups （all P〈0.05）. The levels of hemoglobin and hematoerit in the obese group were significantly higher than those in the normal group（P〈0.05）, while the serum uric acid levels were significantly higher than that in the normal group （P〈0.05）. Antieoagulation was more frequent in the overweight than the normal group（P〈0.05） and Warfarin use was more frequent in the overweight and the obese than the normal group（both P〈0.05）. The mortality rate was higher in the normal group than those in the overweight and the obese groups （both P〈0.01）. Muhiple logistic regression analysis after adjusting for age and sex showed that malignancy （OR=3.716, 95%CI： 1.733-7.972, P=0.001） and high risk PTE （OR= 13.815, 95%C1： 4.093-46.624, P〈0.001） were predictors of mortality, whereas anticoagulation （OR=0.155, 95%C1： 0.056-0.428, P〈O.001）, BMI≥24 （OR=0.142, 95%C1： 0.045-0.446, P=0.001） and BMI≥28 （OR= 0.272, 95%CI： 0.085-0.872, P=0.029） were the predictors of survival, Conclusions Proportion of hypertension, diabetes, coronary heart disease and hyperlipidemia were not significantly different in patients with ove

关 键 词：静脉血栓栓塞症 肺血栓栓塞症 深静脉血栓形成 肥胖 

分 类 号：R589.2[医药卫生—内分泌] R563.5[医药卫生—内科学]