肺血栓栓塞症合并胸腔积液临床特征分析  

Analysis of clinical features of patients with pulmonary thromboembolism complicated with pleural effusion

作　　者：周月 许启霞[1] 庞颖颖[1] 姚宇婷 李洁 ZHOU Yue;XU Qi-xia;PANG Ying-ying;YAO Yu-ting;LI Jie(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院第一附属医院呼吸与危重症医学科

出　　处：《中国实用内科杂志》2019年第12期1064-1068,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家科技支撑计划课题(2011BAI11B17);国家重点研发计划精准医医学专硕(2016YFC0905600)

摘　　要：目的分析合并胸腔积液的肺血栓栓塞症患者的临床特征,探讨影响肺血栓栓塞症引起胸腔积液的因素及肺血栓栓塞症患者预后因素。方法收集蚌埠医学院第一附属医院2012年1月至2018年12月期间,参与肺血栓栓塞症全国多中心注册登记研究数据库150例确诊肺血栓栓塞症患者的临床资料,将肺血栓栓塞症患者分为2组:肺血栓栓塞症合并胸腔积液组和无胸腔积液组。回顾性比较两组患者的人口学特征、基础疾病、临床表现及实验室检查结果之间的差异。结果 150例肺血栓栓塞症患者,其中合并胸腔积液患者48例,占32%。与未合并胸腔积液组相比,肺血栓栓塞症合并胸腔积液组更多见于手术或外伤病史后(22%vs. 8%),胸痛(54%vs. 22%)、呼吸困难(65%vs.39%)及发热(8%vs. 1%)的发生率更高,白细胞计数(10.75×10^9/L vs. 8.56×10^9/L)、C-反应蛋白(67.45 mg/dL vs.17.21mg/dL)、凝血酶原时间(13.75s vs. 12.20s)均增高明显,差异有显著性意义(P均<0.05)。多变量Logistic回归分析显示:C-反应蛋白、胸痛及呼吸困难是肺血栓栓塞症患者合并胸腔积液的独立影响因素(OR值分别为1.011、2.922、2.308,P均<0.05)。Kaplan-Meier生存分析显示肺血栓栓塞症患者合并胸腔积液患者的预后不良。多因素Cox风险回归分析得出胸腔积液是肺血栓栓塞症患者预后不良的独立危险因素。结论肺血栓栓塞症合并胸腔积液的发病率较高尤其是术后或外伤后;不明原因的胸腔积液患者,若出现胸痛及呼吸困难,同时C-反应蛋白升高,应高度怀疑肺血栓栓塞症可能,必要时行计算机断层摄影肺动脉造影以明确诊断。胸腔积液为肺血栓栓塞症患者预后不良的独立危险因素。Objective To analyze the clinical features of patients with pulmonary thromboembolism complicated with pleural effusion and to explore the factors affecting pleural effusion caused by pulmonary thromboembolism and the prognostic factors of patients with pulmonary thromboembolism.Methods Clinical data of 150 patients with confirmed pulmonary thromboembolism were all obtained from the national multi-center registration and research database of pulmonary thromboembolism in our hospital from January 2012 to December 2018.Patients with pulmonary thromboembolism were divided into two groups:group of pulmonary thromboembolism combined with pleural effusion and group without pleural effusion.The differences between the two groups in demographic characteristics,basic diseases,clinical manifestations and laboratory examination results were retrospectively compared.Results In the 150 patients with pulmonary thromboembolism,there were 48 patients with pleural effusion,accounting for 32%.Compared with the without pleural effusion,the pulmonary thromboembolism with pleural effusion was more common after surgery or traumatic history(22% vs.8%),chest pain(54% vs.22%),dyspnea(65% vs.39%)and fever(8% vs.1%)had a higher incidence,white blood cell count(10.75 × 10^9/L vs.8.56×10^9/L),C-reactive protein(67.45 mg/dL vs.17.21 mg/dL)and prothrombin time(13.75 s vs.12.20 s)increased significantly,the difference being significant(P<0.05).Multivariate Logistic regression analysis showed that C-reactive protein,chest pain and dyspnea were independent influencing factors of pleural effusion in patients with pulmonary thromboembolism(OR values were 1.011,2.922,2.308,P<0.05).Kaplan-Meier survival analysis showed that the patients with pleural effusion had poor prognosis.Multivariate Cox risk regression analysis showed that pleural effusion was an independent risk factor for poor prognosis in patients with pulmonary thromboembolism.Conclusion The patients with pulmonary thromboembolism have high incidence of pleural effusion,especially after

关 键 词：肺血栓栓塞症 胸腔积液 预后 

分 类 号：R563.5[医药卫生—呼吸系统]