慢性阻塞性肺疾病合并肺栓塞的短期预后及危险因素分析

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摘要目的探讨慢性阻塞性肺疾病（COPD）合并肺栓塞（PE）的短期预后和危险因素，提高COPD 伴PE 的早期诊断率。方法选择2014年1月～2018年7月我院收治的48 例COPD 合并PE 患者（栓塞组）和50 例慢性阻塞性肺疾病急性加重期（AECOPD）患者（对照组）作为研究对象进行研究，回顾性分析COPD 伴PE 的短期预后和危险因素。结果两组患者的卧床时间≥3 d、下肢不对称水肿、胸痛、死亡率及D-二聚体、动脉血氧分压（PaO2）和N-末端脑钠尿肽前体（NT-proBNP）方面比较，差异有统计学意义（P＜0.05）；在栓塞组中，死亡者（n=9）的超敏肌钙蛋白（hs-TnT）和NT-proBNP 高于存活者（n=39），差异有统计学意义（P＜0.05）。Logistic 回归分析结果显示，卧床时间≥3 d、下肢不对称水肿、D-二聚体≥2.0 μg/ml、PaO2＜60 mmHg 及NT-proBNP≥1200 pg/ml 是COPD 合并PE 的危险因素（P＜0.05）。结论对于COPD 患者，如卧床时间≥3 d、下肢不对称水肿、D-二聚体≥2.0 μg/ml 或PaO2＜60 mmHg、合并心功能不全时，应高度怀疑合并PE。若hs-TnT、NT- proBNP 明显增高，提示其短期预后差。

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	刘翩
	卓玉娟

关键词 ：慢性阻塞性肺疾病, 肺栓塞, 短期预后, 危险因素

Abstract：Objective To study the short-term prognosis andrisk factors for acute pulmonary embolism (PE)in patients with chronic obstructive pulmonary disease (COPD), to improve the early diagnosis rate of COPD with PE. Methods Forty-eight patients with COPD complicated with PE (as embolization group) and 50 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (as control group) admitted to our hospital from January 2014 to July 2018 were selected as subjects for the study. The short-term prognosis and risk factors of COPD with PE were analyzed retrospectively. Results The bed time which was more than 3 days, lower limb asymmetric edema, chest pain, mortality and D-dimer, arterial partial pressure of oxygen (PaO2) and N-terminal brain natriuretic peptide (NT-proBNP) were compared between the two groups, the differences were statistically significant (P＜0.05). In the embolization group, the patients who died (n=9) of hypersensitive troponin T (hs-TnT) and NT-proBNP were higher than those of the survival(n=39), the differences were statistically significant (P＜0.05). Logistic regression analysis results showed that bed time≥3 d, asymmetric edema of lower limbs, D-dimer ≥2.0 μg/ml, PaO2＜60 mmHg and NT-proBNP ≥1200 pg/ml were risk factors for COPD with PE (P＜0.05). Conclusion Patients with COPD have ahigher incidence of PE if they have the risk factors of immobilization ≥3 days, asymmetric edema of lower limbs, D-dimer ≥2.0 μg/ml or PaO2 ＜60 mmHg,and cardiac dysfunction. If the levels of hs-TnT and NT-proBNP are significantly increased, their short-term prognosis is poor.

Key words： Chronic obstructive pulmonary disease Pulmonary embolism Short-term prognosis Risk factors

引用本文:

刘翩；卓玉娟. 慢性阻塞性肺疾病合并肺栓塞的短期预后及危险因素分析[J]. 中国当代医药, 2019, 26(9): 18-21.
LIU Pian；ZHUO Yu-juan. Short-term prognosis and risk factors of chronic obstructive pulmonary disease complicated with pulmonary embolism. 中国当代医药, 2019, 26(9): 18-21.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2019/V26/I9/18

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