【摘要】 目的 探讨不同部位下肢深静脉血栓与急性肺栓塞（APE）并发肺动脉高压严重程度的关系。方法 收集2013年9月至2021年9月于承德医学院附属医院初次确诊为下肢血栓脱落所致急性肺栓塞的280例患者的临床资料。依据心脏彩色多普勒超声检查、下肢血管超声检查、B型脑利钠肽（BNP）水平明确下肢深静脉血栓部位，并按照下肢深静脉血栓的病理解剖部位将患者分为胫腓腘静脉组（n=54）、股腘静脉组（n=99）、下腔髂静脉组（n=15）、小腿肌间静脉组（n=112）。比较不同组别患者的APE后肺动脉高压严重程度。分析不同部位下肢深静脉血栓与BNP水平、肺动脉主干宽度、右室流出道宽度、右室径宽度的关系。分析不同部位下肢深静脉血栓与APE并发肺动脉高压严重程度的相关性。结果 4组患者的性别、年龄、心率、收缩压及舒张压比较，差异均无统计学意义（P> 0.05）。4组患者的APE并发肺动脉高压严重程度、BNP水平比较，差异均有统计学意义（P <0.01）。胫腓腘静脉组患者的BNP水平高于小腿肌间静脉组、股腘静脉组、下腔髂静脉组患者，差异均有统计学意义（P <0.05）；小腿肌间静脉组患者的BNP水平高于股腘静脉组和下腔髂静脉组患者，差异均有统计学意义（P <0.05）；股腘静脉组患者的BNP水平高于下腔髂静脉组患者，差异有统计学意义（P <0.05）。4组患者的肺动脉主干宽度、右室径宽度、右室流出道宽度比较，差异均有统计学意义（P <0.01）。小腿肌间静脉组和胫腓腘静脉组患者的肺动脉主干宽度、右室径宽度、右室流出道宽度均宽于股腘静脉组、下腔髂静脉组患者，差异均有统计学意义（P <0.05）；股腘静脉组患者肺动脉主干宽度、右室径宽度、右室流出道宽度均宽于下腔髂静脉组患者，差异均有统计学意义（P <0.05）。Pearson相关分析结果显示，不同部位下肢深静脉血栓与APE并发肺动脉高压的严重程度均呈正相关（P <0.05）。结论 不同部位的下肢深静脉血栓与APE后肺动脉高压的严重程度存在相关性，并且下肢远心端深静脉血栓形成更容易导致APE后重度肺动脉高压的发生，因此，应当注重对下肢远心端深静脉血栓患者的监测和治疗，防止重度肺动脉高压的发生。更多还原

【Abstract】 Objective To explore the relationship of deep venous thrombosis of lower extremity in different locations with severity of pulmonary hypertension after acute pulmonary embolism(APE). Method The clinical data of 280patients who were first diagnosed with pulmonary embolism caused by lower extremity thrombosis in Affiliated Hospital of Chengde Medical University from September 2013 to September 2021 were collected. According to the color Doppler ultrasound examination of heart, ultrasound examination of blood vessels of lower extremity, and the level of B-type brain natriuretic peptide(BNP), the site of deep venous thrombosis of lower extremity was determined, and the patients were divided into tibiofibular and popliteal vein group(n=54), femoral and popliteal vein group(n=99), inferior vena cava iliac vein group(n=15), calf intermuscular vein group(n=112) according to the pathological and anatomical site of deep venous thrombosis of lower extremity. The severity of APE complicated with pulmonary hypertension was compared among different groups. The relationship of deep venous thrombosis of lower extremity in different locations with the level of BNP, the width of pulmonary artery, the width of right ventricular outflow tract and the width of right ventricular diameter was analyzed. The correlation of deep venous thrombosis of lower extremity in different locations with the severity of APE complicated with pulmonary hypertension was analyzed. Result There were no significant differences in gender, age, heart rate, systolic blood pressure and diastolic blood pressure in 4 groups(P>0.05). There was statistically significant difference in the severity of APE complicated with pulmonary hypertension among 4 groups(P<0.01). The level of BNP in tibiofibular and popliteal vein group was higher than that in calf intermuscular vein group, femoral and popliteal vein group and inferior vena cava iliac vein group, respectively(P<0.05); with higher levels in calf intermuscular vein group than that in femoral and popliteal vein group and inferior vena cava iliac vein group(P<0.05), and higher levels in femoral and popliteal vein group than that in inferior vena cava iliac vein group(P<0.05). There were statistically significant differences in width of pulmonary artery trunk, right ventricular diameter and right ventricular outflow tract among 4 groups(P<0.01), with higher width in calf intermuscular vein group and tibiofibular and popliteal vein group than that in femoral and popliteal vein group and inferior vena cava iliac vein group(P<0.05), and higher width in femoral and popliteal vein group than that in inferior vena cava iliac vein group(P<0.05). Pearson correlation analysis showed that there was a positive correlation between deep venous thrombosis in different parts of lower extremity and the severity of APE complicated with pulmonary hypertension(P<0.05).Conclusion There is a correlation of deep venous thrombosis of lower extremity in different locations with the severity of pulmonary hypertension after APE. In addition, venous thrombosis in distal heart of lower extremity is more likely to lead to severe pulmonary hypertension after APE. Therefore, attention should be paid to the monitoring and treatment of venous thrombosis in distal heart of lower extremity to prevent the occurrence of severe pulmonary hypertension.更多还原