中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2012年
4期
259-263
,共5页
王同生%毛毅敏%孙瑜霞%娄源杰
王同生%毛毅敏%孫瑜霞%婁源傑
왕동생%모의민%손유하%루원걸
肺疾病,慢性阻塞性%肺栓塞%内皮缩血管肽类%D-二聚体
肺疾病,慢性阻塞性%肺栓塞%內皮縮血管肽類%D-二聚體
폐질병,만성조새성%폐전새%내피축혈관태류%D-이취체
Pulmonary disease,chronic obstructive%Pulmonary embolism%Endothelins%D-dimer
目的 探讨非显性因素所致COPD急性加重(AECOPD)发生肺栓塞的临床特征,并研究非显性因素所致AECOPD合并肺栓塞的相关因素.方法 连续纳入因非显性因素所致AECOPD患者208例,年龄50～ 82岁,平均(62±12)岁.入院24 h内进行CT肺动脉造影及双下肢静脉彩超检查,根据造影结果分为合并肺栓组69例和无肺栓塞组139例.均检测动脉血气分析、D-二聚体和内皮素-1.正态分布的计量资料采用t检验,非正态分布资料采用Mann-Whitney u检验,计数资料构成比的比较采用(x)2检验,采用logistic回归方程进行危险因素分析.结果 非显性因素所致AECOPD患者合并肺栓塞者占33％( 69/208)；合并肺栓塞组和无肺栓塞组卧床≥7d者分别占21.7％( 15/208)和13.7％( 19/208),双下肢不等粗≥1 cm者分别占34.8％ (24/208)和15.1％ (21/208),深静脉血栓形成者分别占37.7％ (26/208)和12.2％( 17/208),晕厥者分别占11.6％ (8/208)和0.06％( 9/208),心电图表现为SⅠQⅡTⅢ综合征者分别占11.6％( 8/208)和0.04％ (5/208),PaCO2下降≥5 mm Hg(1 mm Hg=0.133 kPa)者分别占27.5％ (19/208)和9.3％ (13/208),差异均有统计学意义(x2值为4.32～6.79,均P＜0.05).合并肺栓塞组D-二聚体水平[(760±152) μg/L]高于无肺栓塞组[(253±56) μg/L],内皮素-1的中位数(四分位间距)[5.4 ng/L( 1.6～6.9 ng/L)]高于与无肺栓塞组[1.8 ng/L(1.3～4.8)ng/L],差异均有统计学意义(Z值分别为- 2.946和-2.532,均P＜0.01).卧床≥7d、双下肢不等粗≥1 cm和深静脉血栓形成是COPD合行肺栓塞的危险因素(OR值为2.31～3.24,均P＜0.05).结论 非显性因素所致AECOPD患者易合并肺栓塞.卧床时间长、双下肢不等粗和深静脉血栓是合并肺栓塞的相关因素.
目的 探討非顯性因素所緻COPD急性加重(AECOPD)髮生肺栓塞的臨床特徵,併研究非顯性因素所緻AECOPD閤併肺栓塞的相關因素.方法 連續納入因非顯性因素所緻AECOPD患者208例,年齡50～ 82歲,平均(62±12)歲.入院24 h內進行CT肺動脈造影及雙下肢靜脈綵超檢查,根據造影結果分為閤併肺栓組69例和無肺栓塞組139例.均檢測動脈血氣分析、D-二聚體和內皮素-1.正態分佈的計量資料採用t檢驗,非正態分佈資料採用Mann-Whitney u檢驗,計數資料構成比的比較採用(x)2檢驗,採用logistic迴歸方程進行危險因素分析.結果 非顯性因素所緻AECOPD患者閤併肺栓塞者佔33％( 69/208)；閤併肺栓塞組和無肺栓塞組臥床≥7d者分彆佔21.7％( 15/208)和13.7％( 19/208),雙下肢不等粗≥1 cm者分彆佔34.8％ (24/208)和15.1％ (21/208),深靜脈血栓形成者分彆佔37.7％ (26/208)和12.2％( 17/208),暈厥者分彆佔11.6％ (8/208)和0.06％( 9/208),心電圖錶現為SⅠQⅡTⅢ綜閤徵者分彆佔11.6％( 8/208)和0.04％ (5/208),PaCO2下降≥5 mm Hg(1 mm Hg=0.133 kPa)者分彆佔27.5％ (19/208)和9.3％ (13/208),差異均有統計學意義(x2值為4.32～6.79,均P＜0.05).閤併肺栓塞組D-二聚體水平[(760±152) μg/L]高于無肺栓塞組[(253±56) μg/L],內皮素-1的中位數(四分位間距)[5.4 ng/L( 1.6～6.9 ng/L)]高于與無肺栓塞組[1.8 ng/L(1.3～4.8)ng/L],差異均有統計學意義(Z值分彆為- 2.946和-2.532,均P＜0.01).臥床≥7d、雙下肢不等粗≥1 cm和深靜脈血栓形成是COPD閤行肺栓塞的危險因素(OR值為2.31～3.24,均P＜0.05).結論 非顯性因素所緻AECOPD患者易閤併肺栓塞.臥床時間長、雙下肢不等粗和深靜脈血栓是閤併肺栓塞的相關因素.
목적 탐토비현성인소소치COPD급성가중(AECOPD)발생폐전새적림상특정,병연구비현성인소소치AECOPD합병폐전새적상관인소.방법 련속납입인비현성인소소치AECOPD환자208례,년령50～ 82세,평균(62±12)세.입원24 h내진행CT폐동맥조영급쌍하지정맥채초검사,근거조영결과분위합병폐전조69례화무폐전새조139례.균검측동맥혈기분석、D-이취체화내피소-1.정태분포적계량자료채용t검험,비정태분포자료채용Mann-Whitney u검험,계수자료구성비적비교채용(x)2검험,채용logistic회귀방정진행위험인소분석.결과 비현성인소소치AECOPD환자합병폐전새자점33％( 69/208)；합병폐전새조화무폐전새조와상≥7d자분별점21.7％( 15/208)화13.7％( 19/208),쌍하지불등조≥1 cm자분별점34.8％ (24/208)화15.1％ (21/208),심정맥혈전형성자분별점37.7％ (26/208)화12.2％( 17/208),훈궐자분별점11.6％ (8/208)화0.06％( 9/208),심전도표현위SⅠQⅡTⅢ종합정자분별점11.6％( 8/208)화0.04％ (5/208),PaCO2하강≥5 mm Hg(1 mm Hg=0.133 kPa)자분별점27.5％ (19/208)화9.3％ (13/208),차이균유통계학의의(x2치위4.32～6.79,균P＜0.05).합병폐전새조D-이취체수평[(760±152) μg/L]고우무폐전새조[(253±56) μg/L],내피소-1적중위수(사분위간거)[5.4 ng/L( 1.6～6.9 ng/L)]고우여무폐전새조[1.8 ng/L(1.3～4.8)ng/L],차이균유통계학의의(Z치분별위- 2.946화-2.532,균P＜0.01).와상≥7d、쌍하지불등조≥1 cm화심정맥혈전형성시COPD합행폐전새적위험인소(OR치위2.31～3.24,균P＜0.05).결론 비현성인소소치AECOPD환자역합병폐전새.와상시간장、쌍하지불등조화심정맥혈전시합병폐전새적상관인소.
Objective To evaluate the prevalence of pulmonary embolism (PE) in patients with chronic obstructive pulmonary discase (COPD) exacerbations of unknown origin and to explore the risk factors associated with PE.Methods A total of 208 consecutive patients with COPD were referred to this hospital for severe exacerbations of unknown origin.Their age was 50 -82 years,with a mean of (62 ± 12) years.All patients were examined within 48 h of admission by CT pulmonary angiography (CTPA) and lower extremity ultrasonography.The patients were classified as PE positive ( positive results on CTPA) or PE negative (negative results on CTPA).Arterial blood gas,the levels of D-dimer and ET-1 were measured in all the patients.Differences between groups were analyzed using a two-tailed unpaired t test for normally distributed variables and a Mann-Whitney u test for non-normally distributed variables.Qualitative data were assessed using chi-square test,and risk factors were analyzed using logistic regression analysis. Results The frequency of PE was 33％ in this scrics of 208 consecutive patients with COPD referred for exacerbations of unknown origin. There were differences between PE positive and PE negative groups in the following factors (x2 =4.32 - 6.79,mean P ＜ 0.05 ):immobilization ≥ 7 days 21.7％ ( 15/208 ) vs 13.7％(19/208) ; difference in circumference of lower limbs ≥ 1 cm 34.8％ (24/208) vs 15.1％ (21/208) ;deep venous thrombosis (DVT) 37.7％ (26/208) vs 12.2％ ( 17/208 ) ; syncope 11.6％ ( 8/208 ) vs 0.06％ (9/208); SⅠ QⅢTⅢ syndrome 11.6％ (8/208) vs 0.04％ (5/208); decrease in PaCO2 ≥5 mm Hg (1 mm Hg =0.133 kPa) 27.5％ (19/208) vs 9.3％ (13/208).Plasma D-dimer and ET-1 levels were significantly higher in patients with PE as compared to patients without PE.D-dimer levels were (760±152) μg/Land (253 ±56) μg/L (Z=2.946,P＜0.01); ET-1 levelswere5.4 ng/L (1.66.9 ng/L) and 1.8 ng/L ( 1.3 - 4.8 ng/L),Z =- 2.532,P ＜ 0.01.Risk factors identified by logistic rcgrcssion analysis included immobilization ≥ 7 days ( P ＜ 0.05,OR =3.24,95％ CI =1.56 - 4.98 ),difference in cir(e)umference of lower limbs ≥ 1 cm ( P ＜ 0.05,OR =2.56,95％ CI =1.48 - 3.93 ),and deep venous thrombosis (DVT) (P ＜ 0.05,OR =2.31,95％ CI =1.23 -3.58).Conclusions This study showed a 33％ prevalence of PE in palients with COPD who were hospitalized for severe exacerbations of unknown origin.Immobilization ≥7 days,difference in circumference of lower limbs ≥ 1 cm,and DVT were risk factors for PE in this group of patients.
