活动性结核病合并急性肺血栓栓塞症的影响因素分析  

Analysis of related influencing factors of active tuberculosis complicated with acute pulmonary thromboembolism

作　　者：贾月 于洪志[2] JIA Yue;YU Hongzhi(Haihe Clinical School,Tianjin Medical University,Tianjin Institute of Respiratory Diseases,TCM Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine,Tianjin 303500,China;Department of Respiratory,Tianjin Haihe Hospital,Tianjin Institute of Respiratory Diseases,TCM Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine)

机构地区：[1]天津医科大学海河临床学院,天津市呼吸疾病研究所,国家中医药管理局中医药防治传染病重点研究室,303500 [2]天津市海河医院呼吸科,天津市呼吸疾病研究所,国家中医药管理局中医药防治传染病重点研究室

出　　处：《天津医药》2025年第2期165-169,共5页Tianjin Medical Journal

基　　金：天津市第二批卫生健康行业高层次人才选拔培养工程入选人才培养基金资助项目(TJSJMYXYC-D2-012)。

摘　　要：目的 分析活动性结核病(ATB)合并急性肺血栓栓塞症(APTE)患者的影响因素,以便早期干预患者病情进展,改善预后。方法 以121例ATB患者为研究对象,经CT肺动脉造影(CTPA)确诊APTE的41例为ATB+APTE组,80例ATB患者为ATB组。收集并分析2组患者的一般资料,结核病变部位及耐药情况、临床表现和入院后首次实验室指标的差异,采用多因素Logistic回归分析ATB患者并发APTE的影响因素,选取差异有统计学意义的连续性指标绘制受试者工作特征(ROC)曲线,评估预测价值。结果 与ATB组相比,ATB+APTE组年龄大,Padua评分、红细胞分布宽度(RDW)、中性粒细胞/淋巴细胞比值(NLR)、D-二聚体(D-D)水平升高,咳嗽、咳痰比例增加,二氧化碳分压、血红蛋白(Hb)及白蛋白(Alb)水平降低(P<0.05)。多因素Logistic回归分析显示较高的Padua评分、RDW及D-D是ATB合并APTE的危险因素。RDW及D-D预测ATB合并APTE的曲线下面积分别为0.657(95%CI:0.549~0.764)和0.889(95%CI:0.827~0.951)。结论 对于ATB患者,当咳痰频率增加,Padua评分、RDW及D-D升高时,合并APTE的风险增加,须警惕APTE事件的发生。Objective To analyze the factors affecting patients with active tuberculosis(ATB)combined with acute pulmonary thromboembolism(APTE),in order to intervene the progression of the patients'disease early and improve the prognosis.Methods A total of 121 patients with ATB were studied.Forty-one cases with APTE diagnosed by CT pulmonary arteriography(CTPA)were in the ATB+APTE group,and 80 patients with ATB were in the ATB group.The general data of the two groups were collected and analyzed,including the differences in TB lesion sites and drug resistance,clinical manifestations and first laboratory indexes after admission.The influencing factors of ATB patients with concurrent APTE were analyzed by multifactorial Logistic regression,and continuous indexes with significant differences were selected,and the subjects'work characteristics(ROC)curves were plotted to assess the predictive value.Results Compared with the ATB group,patients in the ATB+APTE group were older,and Padua scores were higher,red blood cell distribution width(RDW),neutrophil-to-lymphocyte ratio(NLR),D-dimer were higher,the proportion of cough and expectoration increased and levels of partial pressure of carbon dioxide,hemoglobin(Hb),and albumin were lower(P<0.05).Multifactorial Logistic regression analysis showed that higher Padua score,RDW and D-dimer were risk factors for patients with ATB combined with APTE,and the predicted area under the curve(AUC)for ATB combined with APTE were 0.657(95%CI:0.549-0.764)and 0.889(95%CI:0.827-0.951)for RDW and D-dimer,respectively.Conclusion In patients with ATB,the risk of combined APTE is increased with increased frequency of sputum and elevated Padua score,RDW and D-dimer,alerting to the development of APTE events.

关 键 词：结核 肺 肺栓塞 影响因素分析 

分 类 号：R521.9[医药卫生—内科学]