抗凝治疗对老年与非老年肺栓塞患者D-二聚体的影响

Effects of anticoagulant therapy on D-dimer content in the elderly versus non-elderly patients with pulmonary embolism

目的探讨老年人非大面积肺栓塞的主要临床表现与非老年人的差异及抗凝治疗对老年与非老年肺栓塞患者D-二聚体的不同影响。方法回顾性分析83例确诊为非大面积肺栓塞患者主要临床表现，将其分为老年组39例和非老年组44例，采用免疫比浊法测定患者肺栓塞治疗前、抗凝治疗3d后血浆D-二聚体含量的变化，并比较两组患者的变化特点。结果老年组与非老年组比较，除胸痛分别为14例（35．9％）和30例（68．2％）（Х^2=4．95、P—0．03），其他症状如咳嗽、咯血（均为小量咯血）、晕厥、心悸症状两组发生率差异均无统计学意义（Х^2=2．74、0．06、0．10、0．49、0．01，均P〉0．05）；呼吸急促是最常见且具有临床意义的体征，老年组与非老年组患者呼吸频率〉20次／min的发生率、心动过速、肺动脉瓣区第二音亢进（P2〉A2）或分裂、发热（均为低热）、发绀、颈静脉充盈或搏动的发生率比较，差异均无统计学意义（Х^2=2．60、0．03、0．61、0．06、0．33、0．11，均P〉0．05）。肺栓塞后，治疗前老年组I）_二聚体水平为（1．89±1.21）mg／L，低于非老年组（4．93±3．88）mg／L（Z=-2．55，P=0．01）；抗凝治疗3d后老年组患者D-二聚体含量（1．28±1．11）mg／L，与非老年组患者（2．09±2．22）mg／L比较，差异无统计学意义（Z=-7．07，P-0．50），但两组患者治疗后D-二聚体含量均较治疗前明显降低（Z=-3．34、一3．99，均P〈0．01）；老年组患者治疗后I）_二聚体含量较治疗前降低水平（0．61±1．01）mg／L，与非老年组患者降低水平（2．84±2．95）mg／L比较，差异有统计学意义（Z=-3．54，P=0．001），且治疗后D二聚体变化越明显，患者症状、体征好转亦越明显。结论老年人非大面积肺栓塞的主要临床表现与非老年人相似，但老年人胸痛的发生率较低；肺栓塞后，老年人的D-二聚体含量低于非老年人；抗凝治疗后，老年人的D-二聚体含量变化不如非老年人明显。

Objective To explore the difference of the clinical manifestations between the elderly and non-elderly patients with non-massive pulmonary thromboembolism （PTE） and the significance of D-dimer in the diagnosis of PTE and its dynamic change after anticoagulant therapy. Methods The clinical manifestations of 83 cases with PTE were retrospectively analysed and divided into two groups： 39 elderly and 44 non-elderly. The dynamic changing of D-dimer content was determined by immunoturbidimetry（ITM） method before and 3 d after anticoagulant therapy in the two groups. Results There were no significant statistical differences in the incidence of the main symptoms： dyspnea, cough, emptysis, syncope, palpitations between the elderly and the non-elderly （Х^2=2.74, 0.06, 0.10, 0.49, 0.01, P〉0.05） except for the incidence of chest pain [14 cases （35.9%） vs. 30 cases（ 68.2%）,X^2=4.95, P〈0.05]. No differences were found in the the main signs： shortness of breath, tachycardia, accentuation or split of second pulmonary valve sound,cyanosis, and engorgement of neck veins between the two groups（X^2 =2.60, 0.03, 0.61, 0.06, 0.33, 0. 11,P〉0.05）, D-dimer content was lower in the elderly than in the non-elderly 〈（1.89± 1.21） mg/L vs. （4.93±3.88） mg/L,Z=-2.55, P=0.01） before anticoagulant therapy. But there was no difference in D -dimer content between the two groups 3 d after anticoagulant therapy 〈（1.28± 1.11） mg/L vs. （2.09±2.22） rag/L, Z=-7.07, P=0.50）. The decreasing levelo{ D-dimer was less prominent in the elderly than in the non-elderly [（0. 61±1. 01） mg/Lvs. （2.84±2.95） rag/L, Z = -3.54, P=0. 0011. Conclusions The main clinical manifestations are similar between the elderly and non-elderly with non-massive PTE, but the incidence of chest pain is less in the elderly than in the non elderly. The content of D- dimer is lower in the elderly than non-elderly after PTE and its decrements are less prominent in the elderly than the non-elderly after anticoagulant therapy.