【摘要】 目的探索无法解释原因的慢性阻塞性肺疾病急性加重(AECOPD)发生肺栓塞(PE)的临床特征,并研究无法解释原因的AECOPD合并PE的危险因素。方法连续纳入无法解释原因的AECOPD患者208例(年龄50～82岁,平均62岁),入院24 h内行螺旋CT肺动脉造影(CTPA)及双下肢静脉彩超检查,根据CTPA结果分为合并PE组和无PE组。均检测动脉血气、D-二聚体(D-dimer)、内皮素-1(ET-1)。结果 208例无法解释原因的AE-COPD患者中,69例(33.2%)合并PE,139例(66.8%)患者无合并PE。合并PE组与无PE组的临床因素相比较:卧床≥7 d分别为15例(21.7%)和19例(13.7%);双下肢不等粗≥1 cm分别为24例(34.8%)和21例(15.1%);深静脉血栓形成分别为26例(37.7%)和17例(12.2%);晕厥分别为8例(11.6%)和9例(6.5%);心电图表现SⅠQⅢTⅢ综合征分别为8例(11.6%)和5例(3.6%);动脉血二氧化碳分压(PaCO2)下降≥5 mm Hg分别为19例(27.5%)和13例(9.4%),差异有统计学意义(χ2值为4.32～6.79,P<0.05)。合并PE组D-dimer和内皮素-1水平高于非PE组,D-dimer分别是(760±152)μg/L与(253±56)μg/L,差异有统计学意义(P<0.01);内皮素-1水平分别是中位数5.4 pg/L(四分位数间距,1.6～6.9 pg/L)与中位数1.8 pg/L(四分位数间距,1.3～4.8 pg/L),差异有统计学意义(Z=-2.532,P<0.01)。D-dimer和ET-1水平正相关(r=0.452,P=0.001);动脉血氧分压(PaO2)和ET-1负相关(r=-0.659,P=0.031)。结论不能解释原因的AECOPD患者有33.2%合并PE。卧床≥7 d、双下肢不等粗≥1 cm、深静脉血栓形成、晕厥、心电图表现SⅠQⅢTⅢ征、PaCO2下降≥5mm Hg、D-dimer≥500μg/L以及ET-1水平增高是合并PE的高危因素。更多还原

【Abstract】 Objective To investigate the clinical characteristics of un-explained pulmonary embolism(PE) in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and study the unknown origin and risk factors associated with PE.Methods A total of 208 AECOPD patients,aged 50~82 years with mean age 62 years,with unknown origin were consecutively enrolled.All patients,within 48 hours of admission to the hospital,were examined by CT pulmonary angiography(CTPA) and ultrasonography of two lower limbs.The patients were classified as PE positive and PE negative groups according to the results of CTPA.Arterial blood gas and the levels of D-dimer and endothelin(ET)-1 were investigated for all the patients.Results Among all the 208 patients with AECOPD,69(33.2%) had a complication of PE and 139(66.8%)had no PE.For the PE and non-PE groups,the number of patients whose immobilization time≥7days was 15(21.7%) vs.19(13.7%),whose difference of two lower limbs in thickness ≥1 cm was 24(34.8%) vs.21(15.1%);who had deep venous thrombosis(DVT) was 26(37.7%) vs.17(12.2%);who had syncope was 8(11.6%)vs.9(6.5%);whose EKG showed SⅠQⅢTⅢ syndrome was 8(11.6%) vs.5(3.6%);whose decrease of arterial partial pressure of carbon dioxide(PaCO2)≥5 mm Hg was 19(27.5%) vs.13(9.4%),with statistical differences(χ2=4.32~6.79,P<0.05).For patients with PE and with no PE,plasma D-dimer level was(760±152)μg /L vs.(253±56)μg /L,with a statistical difference(P<0.01);and the median of ET-1 was 5.4 pg/L(interquartile range:1.6~6.9 pg/L) vs.1.8 pg/L(interquartile range:1.3~4.8 pg/L),with a statistical difference(Z=-2.532,P<0.01).There was a positive correlation between D-dimer and ET-1 levels(r=0.452,P=0.001),and a negative correlation between arterial partial pressure of oxygen(PaO2) and ET-1 levels(r=-0.659,P=0.031).Conclusion About 33.2% of the AECOPD patients with unknown origin have PE complication;and the higher risk factors are immobilization time≥7 days,difference of two lower limbs in thickness ≥1 cm,deep venous thrombosis,syncope,SⅠQⅢTⅢsyndrome in EKG,decrease of PaCO2≥5 mm Hg,plasma D-dimer≥500 μg /L,and increase of ET-1 level.更多还原