摘要
目的评估慢性阻塞性肺疾病急性加重期(AECOPD)中肺栓塞(PE)的患病率,比较AECOPD合并PE的辅助检查及临床特征。方法一项前瞻性、多中心研究纳入2016年12月—2023年1月在中国8所医院呼吸科住院的AECOPD患者,行CT肺动脉造影明确是否合并PE,收集并比较患者临床资料。结果共纳入731例AECOPD患者,PE患病率为15.3%。AECOPD合并PE者少痰(81.3%vs 42.0%,P<0.01)、胸痛(24.1%vs 9.2%)、咯血(11.6%vs 2.0%)、心悸(24.1%vs 0.5%)和晕厥(6.3%vs 0.2%)的发生率均明显高于单纯AECOPD者(P<0.001)。AECOPD合并PE组与单纯AECOPD组相比,PaO_(2)为(76.27±26.22)mm Hg vs(76.01±25.67)mm Hg,PaCO_(2)为(45.63±15.13)mm Hg vs(47.23±13.11)mm Hg,两组未见统计学差异(P>0.05)。多因素逻辑回归分析显示D-二聚体(OR=52.608,95%CI 10.610~206.068)、N末端脑钠肽前体(OR=3.013,95%CI 1.532~4.013)和少痰(OR=5.103,95%CI 2.953~8.635)是AECOPD发生PE的相关因素。影像学方面,112例PE患者中,双侧PE有69例(61.6%),多发PE有73例(65.2%)。血栓位置在主肺动脉干者有5例(4.5%),在左、右肺动脉干以上的有16例(14.3%),在叶支肺动脉及以上者有44例(39.3%),在段、亚段及以下肺动脉者的有13例(11.6%)。按照PE危险分层,高危PE有0例;中危PE有44例(39.3%),其中,中高危PE有15例(13.4%),中低危PE有29例(25.9%);低危PE有68例(60.7%)。结论AECOPD合并PE的比例很高,出现胸痛、咯血、心悸和晕厥需考虑到合并PE的可能性;D-二聚体、N末端脑钠肽前体水平升高和少痰是AECOPD患者发生PE的重要相关因素,提示住院AECOPD合并PE患者可能无明显的咳痰症状,导致慢性阻塞性肺疾病急性加重的原因并非感染,可能是合并了PE。AECOPD患者合并PE的血栓位置符合一般PE的解剖学特点,危险分层以低危为主,高危少见。
Objective To evaluate the prevalence of pulmonary embolism(PE)in acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to compare the auxiliary examinations and clinical features of AECOPD combined with PE.Methods A prospective,multicenter study was conducted on AECOPD patients admitted to the respiratory department in 8 Chinese hospitals from December 2016 to January 2023.Computed tomographic pulmonary angiography was performed to determine whether PE was present,and clinical data of patients were collected and compared.Results A total of 731 AECOPD patients were included,with a PE prevalence rate of 15.3%.The incidence of reduced sputum(81.3%vs 42.0%,P<0.01),chest pain(24.1%vs 9.2%),hemoptysis(11.6%vs 2.0%),palpitations(24.1%vs 0.5%)and syncope(6.3%vs 0.2%)in AECOPD patients with PE were significantly higher than those in AECOPD patients alone(P<0.001).Compared with the AECOPD group with PE alone,the PaO_(2) was(76.27±26.22)mm Hg vs(76.01±25.67)mm Hg and PaCO_(2) was(45.63±15.13)mm Hg vs(47.23±13.11)mm Hg,and there was no statistically significant difference between the two groups(P>0.05).Multivariate logistic regression analysis showed that D-dimer(OR=52.608,95%CI 10.610~206.068),N-terminal pro-brain natriuretic peptide(OR=3.013,95%CI 1.532~4.013),and reduced sputum(OR=5.103,95%CI 2.953~8.635)were related factors for the occurrence of PE in AECOPD.In terms of imaging,among the 112 cases of PE,there were 69 cases(61.6%)of bilateral PE and 73 cases(65.2%)of multiple PE.There were 5 cases(4.5%)with thrombus located on the main pulmonary artery trunk,16 cases(14.3%)above the left and right pulmonary artery trunk,44 cases(39.3%)above the lobar pulmonary artery,and 13 cases(11.6%)above the segmental,subsegmental and lower pulmonary arteries.According to the risk stratification of PE,there were 0 case of high-risk PE;44 cases of medium risk PE(39.3%),among them,there were 15 cases of medium high risk PE(13.4%)and 29 cases of medium low risk PE(25.9%);68 cases of low risk PE(60.7%).Conclusion The
作者
焦小净
龚娟妮
邝土光
李积凤
张一笑
杨媛华
JIAO Xiaojing;GONG Juanni;KUANG Tuguang;LI Jifeng;ZHANG Yixiao;YANG Yuanhua(Department of Respiratory and Critical Care Medicine,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China)
出处
《心血管病学进展》
CAS
2024年第1期84-90,共7页
Advances in Cardiovascular Diseases
关键词
慢性阻塞性肺疾病急性加重期
肺栓塞
患病率
临床特征
Acute exacerbation of chronic obstructive pulmonary disease
Pulmonary embolism
Incidence rate
Clinical features
