326例老年急性肺血栓栓塞症患者外周血白细胞升高的相关因素及预后分析  

Related factors and prognosis of elevated peripheral blood leukocyte count in 326 elderly patients with acute pulmonary thromboembolism

作　　者：田雪婧 朱毅 李南 陈玲 刘扣英 孔辉 解卫平 TIAN Xuejing;ZHU Yi;LI Nan;CHEN Ling;LIU Kouying;KONG Hui;XIE Weiping(Department of Respiratory,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院呼吸与危重症医学科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2022年第6期837-842,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家科技重大专项(2018ZX10722301-002)。

摘　　要：目的:通过探讨老年急性肺血栓栓塞症(acute pulmonary thromboembolism,APTE)患者外周血白细胞(peripheral blood leukocytes,PBL)升高的相关因素及其预后意义,提高临床医生对APTE的认识。方法:收集南京医科大学第一附属医院2016年1月—2019年6月60岁以上老年住院APTE患者326例,分析患者PBL升高的原因及预后意义。采用Logistic回归方法,比较分析PBL升高组(n=78)和PBL正常组(n=248)患者的年龄、性别、D-二聚体水平、肺动脉栓塞部位、近端深静脉血栓(deep vein thrombosis,DVT)、远端DVT、基础疾病、深静脉置管、吸烟史、糖皮质激素的应用。结果:下肢近端、远端均存在DVT患者的PBL显著高于无DVT组和仅下肢远端DVT组(P<0.05)。统计学分析显示,心力衰竭、近期(<30 d)骨折、间质性肺病和D-二聚体水平是老年APTE患者PBL升高的相关因素(P<0.05)。PBL升高组溶栓比例、在院死亡、血管活性药物使用、机械通气使用、心肺复苏率均高于PBL正常组(P<0.05)。结论:PBL升高的老年APTE患者预后较差,需要重点关注心肺功能不全、下肢近端及远端均存在DVT的老年APTE患者。Objective:This study aims to investigate the related factors and prognosis of peripheral blood leukocyte(PBL)in elderly patients with acute pulmonary thromboembolism(APTE).Methods:Total 326 elderly patients over 60 years old that were hospitalized and diagnosed APTE in the First Affiliated Hospital of Nanjing Medical University from January 2016 to June 2019 were enrolled.Patients were divided into elevated PBL group(n=78)and normal PBL group(n=248).Logistic regression was used to analyze the factors associated to PBL elevation in elderly APTE patients,including the age,gender,D-dimer level,pulmonary embolism site,proximal deep vein thrombosis(DVT),distal DVT,basic diseases,deep venous catheterization,smoking history and glucocorticoid application.Results:The PBL in the group with proximal-distal lower extremity DVT was significantly higher than those in the group without DVT and the group with distal lower extremity DVT only(P<0.05).Statistical analysis and logistic regression analysis showed that heart failure,recent(<30 days)fracture,interstitial lung disease,and D-dimer levels were associated factors of elevated PBL in elderly patients with APTE(P<0.05).The incidence of adverse events(including mortality in hospital,use of vasoactive drugs,use of mechanical ventilation,cardiopulmonary resuscitation,etc.)in the elevated PBL group was higher than that in the normal PBL group(P<0.05).Conclusion:The prognosis of elderly APTE patients with elevated PBL was worse.We need to pay more attention to elderly APTE patients with cardiac and pulmonary insufficiency and DVT in proximal-distal lower extremity.

关 键 词：急性肺血栓栓塞症 外周血白细胞计数 下肢深静脉血栓 老年患者 预后 

分 类 号：R563.5[医药卫生—呼吸系统]