不同部位DVT与APTE后肺动脉主干宽度、右心室流出道宽度、右心室径水平的相关性

Correlation of deep vein thrombosis in different parts of lower extremity with the width of pulmonary trunk,the width of right ventricular outflow tract and the right ventricular diameter after acute pulmonary thromboembolism and the influencing factors

目的探讨不同部位下肢深静脉血栓形成(DVT)与急性肺血栓栓塞症(APTE)后肺动脉主干宽度、右室流出道宽度、右心室径水平的相关性及影响因素。方法选择2013年10月至2020年8月初次确诊为APTE患者231例,分为小腿肌间静脉型血栓组(n=94)、胫腓腘静脉血栓组(n=31)、股腘静脉型血栓组(n=90)和下腔髂静脉型血栓组(n=16)。统计4组临床资料;心脏彩色多普勒超声诊断仪测定肺动脉主干宽度、右心室流出道宽度和右心室径水平;Pearson检验法分析DVT与APTE后肺动脉主干宽度、右心室流出道宽度、右心室径水平的相关性。多元逐步Logistic回归分析探讨APTE后DVT部位的影响因素。结果4组肺动脉主干宽度、右心室流出道宽度、右心室径水平比较,差异均有统计学意义(P<0.05)。其中,小腿肌间静脉型血栓组与股腘静脉型血栓组、下腔髂静脉型血栓组比较,患者肺动脉主干宽度、右心室流出道宽度、右心室径水平明显升高(P<0.05);胫腓静脉型血栓组、股腘静脉型血栓组与下腔髂静脉型血栓组比较,患者肺动脉主干宽度、右心室流出道宽度、右心室径水平均升高(P<0.05)。不同部位DVT与APTE后肺动脉主干宽度、右心室流出道宽度和右心室径水平呈显著正相关关系(P<0.01)。多元逐步Logistic回归分析显示,肺动脉主干宽度、右心室流出道宽度、右心室径水平是DVT部位的影响因素(P<0.01)。结论不同部位DVT与APTE后肺动脉主干宽度、右心室流出道宽度、右心室径水平具有相关性,且是DVT患者APTE后的主要病理生理变化;肺动脉主干宽度、右心室流出道宽度、右心室径水平在诊断不同部位DVT患者病情方面具有一定的价值。

Objective To investigate the correlation of deep vein thrombosis(DVT)in different parts of lower extremity with the width of pulmonary trunk,the width of right ventricular outflow tract and the right ventricular diameter after acute pulmonary thromboembolism(APTE)and the influencing factors.Methods A total of 231 patients who were initially diagnosed as APTE from October 2013 to August 2020 were recruited.They were divided into leg intermuscular vein thrombosis group(n=94),tibiofibular popliteal vein thrombosis group(n=31),femoral popliteal vein thrombosis group(n=90)and inferior iliac vein thrombosis group(n=16).The width of pulmonary artery trunk,the width of right ventricular outflow tract and the right ventricular diameter were measured by color Doppler echocardiography,and their correlation was analyzed by Pearson’s correlation test.Multivariate stepwise logistic regression analysis was carried out to explore the influencing factors for the location of lower extremity deep vein thrombosis after APTE.Results There were significant differences in the width of pulmonary artery trunk,the width of right ventricular outflow tract and the right ventricular diameter among the four groups(P<0.05).Among them,the width of pulmonary artery trunk,the width of right ventricular outflow tract and the right ventricular diameter in the leg intermuscular vein thrombosis group were significantly higher than those of the femoral popliteal vein thrombosis group and the inferior iliac vein thrombosis group(P<0.05).The width of pulmonary artery trunk,the width of right ventricular outflow tract and the right ventricular diameter were significantly larger in patients with tibiofibular vein thrombosis group and femoral popliteal vein thrombosis group than those of inferior iliac vein thrombosis group(P<0.05).There was a significant positive correlation of DVT at different sites with the width of pulmonary artery trunk,the width of right ventricular outflow tract and the right ventricular diameter after APTE(P<0.01).Multivariate stepwise Logistic regression analysis showed that the width of pulmonary artery trunk,the width of right ventricular outflow tract,and the right ventricular diameter were the influencing factors for the location of DVT in lower limbs(P<0.01).Conclusion DVT at different sites is correlated with the width of pulmonary artery trunk,the width of right ventricular outflow tract and the right ventricular diameter after APTE,serving as the main pathophysiological changes after APTE)in patients with DVT of lower limbs.The width of main pulmonary artery,the width of right ventricular outflow tract,and the right ventricular diameter exert diagnostic values in DVT at different parts.