摘要
目的:探讨吸烟与急性肺栓塞(APE)危险分层及严重程度的相关性,并分析吸烟对急性肺栓塞病人肺动脉压力的影响。方法:回顾性分析2016年3月1日—2021年12月1日于南京大学医学院附属鼓楼医院和南京医科大学第一附属医院急诊就诊的244例APE病人的临床资料,根据病情严重程度分为非危重组(186例)和危重组(58例)。采用多因素Logistic回归分析引起危重肺栓塞的相关危险因素,并根据多因素分析结果剔除存在其他干扰因素的病人,根据CT肺动脉造影严重程度分数(CT-PASS)剔除慢性肺部疾病后剩余病例分为堵塞严重组(CT-PASS>20 mm,53例)和堵塞非严重组(CT-PASS≤20 mm,151例),比较两组吸烟者和非吸烟者的APE危重程度和肺动脉压力。分析吸烟与急性肺栓塞危险分层及严重程度的相关性、吸烟对急性肺栓塞病人肺动脉压力的影响。结果:吸烟、慢性肺部疾病、CT-PASS是导致急性肺栓塞危重状况的独立危险因素。在剔除40例存在慢性肺部疾病的病人后,在堵塞非严重组中,吸烟者存在肺动脉高压的占比明显高于非吸烟者(P<0.05),尽管两组危重肺栓塞占比比较差异无统计学意义(P>0.05),但吸烟者危重肺栓塞比例仍高于非吸烟者;在堵塞严重组中,两组存在肺动脉高压的占比比较差异无统计学意义(P>0.05),但吸烟者出现重度肺动脉高压和危重肺栓塞的比例明显高于非吸烟者(P<0.05)。结论:吸烟是急性肺栓塞危险分层及严重程度的独立危险因素,吸烟者发生重度肺动脉高压和危重肺栓塞的风险程度较不吸烟者高,吸烟通过引起并加重肺动脉高压进而增加急性肺栓塞的危害性,在合并严重堵塞情况下更易导致危重肺栓塞。
Objective:To investigate the correlation between smoking and risk stratification and severity of acute pulmonary embolism(APE).Methods:The clinical data of 244 patients with APE were divided into non-critical group(186 cases)and critical group(58 cases)according to the severity of the disease.Multivariate Logistic regression analysis was used to analyze the risk factors causing critical APE,and patients with other interfering factors were excluded according to the results of multivariate analysis.According to the CT pulmonary angiography severity score(CT-PASS),the remaining cases after the elimination of chronic pulmonary disease were divided into the severe blockage group(CT-PASS>20 mm,53 cases)and non-severe blockage group(CT-PASS≤20 mm,151 cases).APE severity and pulmonary artery pressure were compared between two groups.The correlation between smoking and risk stratification and severity of APE,and the effect of smoking on pulmonary pressure in patients with APE was analysed.Results:Smoking,chronic pulmonary disease,and CT-PASS were independent risk factors for APE.After excluding 40 patients with chronic lung disease in the non-severe blockage group,the proportion of smokers with pulmonary hypertension was significantly higher than that of non-smokers(P<0.05).Although there was no significant difference in the proportion of critical APE between two groups(P>0.05),the proportion of smokers with critical APE was still higher than that of non-smokers in the severe blockage group.There was no significant difference in the proportion of pulmonary hypertension between the two groups(P>0.05),but the proportion of severe pulmonary hypertension and critical APE in smokers was significantly higher than that in non-smokers(P<0.05).Conclusion:Smoking is an independent risk factor for the risk stratification and severity of APE.Smokers is a higher risk of severe pulmonary hypertension and critical APE.Smoking could increase the risk of APE by causing and aggravating pulmonary hypertension,and it is more likely to lead
作者
邵斌霞
王玮
何斌
张劲松
高玉娟
仝瀚文
SHAO Binxia;WANG Wei;HE Bin;ZHANG Jingsong;GAO Yujuan;TONG Hanwen(The Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China)
出处
《中西医结合心脑血管病杂志》
2023年第11期2032-2036,共5页
Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease
基金
国家自然科学基金项目(No.81900062)
江苏省卫生健康委员会面上项目(No.H2019108)。
关键词
急性肺栓塞
肺动脉高压
吸烟
危险分层
严重程度
acute pulmonary embolism
pulmonary artery hypertension
smoking
risk stratification
severity
