不伴红细胞增多的慢性阻塞性肺疾病患者并发肺栓塞的影响因素研究  

Risk Factors for Pulmonary Embolism in Patients with Chronic Obstructive Pulmonary Disease without Erythrocythemia

作　　者：孙峰[1] 燕存子[1] 夏宇[1] 王在义[1] 

机构地区：[1]新疆医科大学第一附属医院呼吸与呼吸危重症中心,新疆乌鲁木齐市830054

出　　处：《中国全科医学》2020年第24期3018-3022,共5页Chinese General Practice

基　　金：国家重点研发计划(2016YFC0905600)。

摘　　要：背景慢性阻塞性肺疾病(COPD)患者肺栓塞(PE)发生率显著高于常人,但目前不伴红细胞增多的COPD患者并发PE的机制尚不明确。目的探讨不伴红细胞增多的COPD患者并发PE的影响因素。方法本研究为回顾性病例对照研究。收集2017年1—12月在新疆医科大学第一附属医院呼吸与呼吸危重症中心住院治疗的血红蛋白(Hb)≤140 g/L的COPD患者。依据肺多层螺旋CT肺血管成像(CTPA)检查结果将患者分为并发PE组和单纯COPD组。记录患者的年龄、性别、合并症、服用抗血小板或抗凝药物史。采用倾向性评分匹配(PSM)方法,通过二元Logistic回归分析估计倾向性评分值,采用1∶1最邻近原则匹配,卡钳值为0.05,筛选出基线相同的两组病例。记录患者的D-二聚体、血常规检查结果,比较两组间差异;分析不伴红细胞增多的COPD患者并发PE的影响因素,红细胞分布宽度(RDW)与中性粒细胞/淋巴细胞比值(NLR)的相关性。结果共纳入病例339例,其中单纯COPD组289例,并发PE组50例。采用PSM方法筛选两组患者,最终得到单纯COPD组、并发PE组各50例进行后续研究。并发PE组患者D-二聚体、中性粒细胞计数(N)、RDW、NLR高于单纯COPD组,淋巴细胞计数(L)低于单纯COPD组(P<0.05)。二元Logistic回归分析结果显示,RDW是不伴红细胞增多的COPD患者并发PE的影响因素〔OR=1.561,95%CI(1.096,2.225),P<0.05〕。Spearman秩相关分析结果显示,不伴红细胞增多的COPD患者RDW与NLR呈正相关(rs=0.225,P<0.05)。结论RDW升高是Hb≤140 g/L的COPD患者并发PE的危险因素,且RDW与NLR呈正相关。Background The incidence of pulmonary embolism(PE) in chronic obstructive pulmonary disease(COPD) patients is significantly higher than that in the general population,but the mechanism of PE in such patients without erythrocytosis is unclear.Objective To analyze the risk factors for PE in patients with COPD without erythrocythemia.Methods A retrospective case-control study was conducted.From January to December 2017,inpatients with COPD whose hemoglobin was no more than 140 g/L were recruited from Respiratory and Respiratory Critical Care Center,the First Affiliated Hospital of Xinjiang Medical University,They were classified as COPD+PE group and COPD group according to the result of multislice spiral CT pulmonary angiography(CTPA).Data about age,gender,comorbidities,medication history of anticoagulant or antiplatelet agents were collected.Those in the two groups with similar baseline data were screened by propensity score matching using the binary Logistic regression with the principle of 1∶1 k-nearest neighbor,and a calipers value of 0.05.D-dimer level and routine blood test parameters were recorded and compared between the two groups.Factors associated with PE in COPD without erythrocythemia,and the correlation between red blood cell distribution width(RDW) and neutrophil to lymphocyte ratio(NLR) were analyzed.Results Of the initially selected 339 cases,50 had PE,and other 289 had not.The finally enrolled participants included 50 with PE,and 50 without.Those with PE showed higher mean levels of D-dimer,neutrophil count,RDW,and NLR,but lower mean level of lymphocyte count(P<0.05).Binary Logistic regression analysis showed that RDW was associated with PE in COPD without erythrocythemia〔OR=1.561,95%CI(1.096,2.225),P<0.05〕.Spearman’s correlation analysis showed that RDW was positively correlated with NLR in COPD patients without erythrocythemia(rs=0.225,P<0.05).Conclusion In COPD patients with hemoglobin ≤ 140 g/L,increased RDW may increase the risk of complicating with PE,and RDW was positively correlat

关 键 词：肺疾病 慢性阻塞性 肺栓塞 红细胞增多 血红蛋白类 危险因素 

分 类 号：R563.9[医药卫生—呼吸系统]