急性肺栓塞患者远期死亡危险因素及超声心动图的预测价值探讨  

Risk factors of long-term mortality in patients with acute pulmonary embolism and the predictive value of echocardiography

作　　者：李奕莹[1] 陈武[1] 郝美芳[1] 徐琨[1] 刘晓芳[1] 杨永生[1] 李廷廷[1] Li Yiying;Chen Wu;Hao Meifang;Xu Kun;Liu Xiaofang;Yang Yongsheng;Li Tingting(Department of Ultrasonography,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院超声科,太原030001

出　　处：《中华全科医师杂志》2022年第5期457-463,共7页Chinese Journal of General Practitioners

基　　金：山西省科技攻关项目(20140313013-6);山西医科大学校级科研基金(01201416)。

摘　　要：目的回顾急性肺栓塞(APE)患者抗栓治疗后的长期随访资料,分析超声心动图对急性肺栓塞长期预后的预测价值,以及远期死亡相关的危险因素。方法收集2010年12月至2014年11月在山西医科大学第一医院就诊并经CT肺动脉血管成像或肺通气灌注显像确诊的急性肺栓塞患者109例,收集患者发病48 h内经胸超声心动图(TTE)参数、临床资料。所有患者经过临床规范化抗凝、溶栓或取栓治疗,并定期进行随访,随访(7.20±1.04)年,根据随访结果分为生存组与死亡组。采用t检验或χ^(2)检验比较2组患者发病后48 h内的超声心动图参数、初次生化实验室指标,用Cox回归分析影响急性肺栓塞患者远期预后的危险因素。采用Kaplan-Meier法对超声心动图评价患者有右心室扩大和/或功能障碍和无右心室扩大和/或功能障碍患者进行生存分析,并绘制生存曲线,两组间比较采用log-rank检验。结果排除失访患者14例,其余95例纳入患者中生存者58例,死亡者37例,全因死亡率为39.0%。高龄(HR=2.32,95%CI:1.31~4.13,P=0.004)、恶性肿瘤(HR=6.49,95%CI:2.32~18.14,P<0.001)、右心房(RA)/左心房(LA)面积比增高(HR=2.01,95%CI:1.16~3.48,P=0.013)、右心室扩大和/或功能障碍(HR=5.90,95%CI:1.45~23.94,P=0.013)、Charlson合并症指数(CCI)评分增高(HR=1.75,95%CI:1.04~2.96,P=0.035)、低血氧饱和度(HR=1.70,95%CI:1.14~2.53,P=0.009)为急性肺栓塞患者远期死亡相关的独立危险因素。Kaplan-Meier生存曲线分析显示,右心室扩大和/或功能障碍组患者随访1、3、5和7年的累计生存率分别为92.8%、66.7%、59.4%和52.2%,无右心室扩大和/或功能障碍组患者随访1、3、5和7年的累计生存率分别为96.2%、92.3%、84.6%和84.6%,差异有统计学意义(P=0.006)。结论急性肺栓塞患者远期死亡率高,早期超声心动图右心室扩大和/或功能障碍、RA/LA面积比增高、高龄、恶性肿瘤、CCI评分增高、低血氧饱和度是急性�Objective To investigate the risk factors of long-term mortality in patients with acute pulmonary embolism(APE)and to explore the predictive value of echocardiography.Methods A total of 109 APE patients admitted in First Hospital of Shanxi Medical University between December 2010 and November 2014 were enrolled in this study.APE was diagnosed by computed tomography pulmonary angiography(CTPA)or ventilation-perfusion pulmonary scintigraphy.Transthoracic echocardiography(TTE)parameters and clinical parameters within 48 h of onset were collected.All the patients were treated with standard anticoagulation,thrombolysis,or thrombectomy.Regular follow-up was carried out,with the average follow-up period of(7.20±1.04)years.The patients were divided into survival group and fatal group according to their follow-up results.The echocardiographic parameters and primary biochemical laboratory parameters within 48 h after onset were compared between the survival group and the fatal group by t test orχ^(2) test.Cox regression analysis was conducted to analyze the influencing factors of long-term prognosis of patients with APE.Survival analysis was performed in patients with echocardiographic assessment of right ventricular(RV)enlargement and/or dysfunction and without RV enlargement and/or dysfunction by Kaplan-Meier method,and the survival curves were plotted.The comparison between the two groups was performed by log-rank test.Results The average follow-up period was(7.20±1.04)years.Fourteen patients were lost in the follow-up,and 95 patients were included in the final analysis,among whom 58 survived and 37 died with a fatality rate of 39.0%.Cox regression analysis showed that age(HR=2.32,95%CI:1.31-4.13,P=0.004),malignancy(HR=6.49,95%CI:2.32-18.14,P<0.001),right atrial(RA)/left atrial(LA)area ratio(HR=2.01,95%CI:1.16-3.48,P=0.013),RV enlargement and/or dysfunction(HR=5.90,95%CI:1.45-23.94,P=0.013),Charlson comorbidity index(CCI)score(HR=1.75,95%CI:1.04-2.96,P=0.035),low oxygen saturation(HR=1.70,95%CI:1.14-2.53,P=0.009)were

关 键 词：肺栓塞 死亡率 预后 危险因素 超声心动描记术 

分 类 号：R563.5[医药卫生—呼吸系统]