血液中炎症相关指标的动态变化及其与静脉血栓栓塞症的相关性

Dynamic changes of inflammation-related indices in venous thromboembolism and the associationbetween these indices and venous thromboembolism

目的探讨血液中炎症相关指标在静脉血栓栓塞症（VTE）病程中的动态变化及其与VTE的相关性。方法将2010年1至12月于北京朝阳医院呼吸与危重症医学科收治的95例VTE患者（男41例，女54例）的血液中白细胞计数（WBC）、中性粒细胞（NE）、纤维蛋白原（FBG）、C反应蛋白（CRP）、红细胞沉降率（ESR）等炎症相关指标与正常参考值范围进行比较，回顾性分析不同病程分期这些指标的动态变化，并根据性别、年龄、VTE类型、体质指数、吸烟状态、病变特点分别对患者进行分组分析，探讨这些指标与VTE的相关性。结果VTE患者血液中NE（0．72）、CRP（15．0mg／L）及男性患者ESR（20．0mm／1h）水平均高于正常参考值范围，而WBC（男7．27×10’／L、女8．67×10’／L）、FBG（男3621ms／L、女5201ms／L）及女性患者的ESR（19．5ram／1h）水平均在正常参考值范围。CRP在VTE急性期（平均秩次值49．72）和亚急性期（平均秩次值44．80）高于慢性期（平均秩次值30．25）；年龄〉150岁者FBG、CRP、ESR高于年龄〈50岁者（平均秩次值分别为48．83比34．53，44．32比28．90，45．95比27．84）；非肥胖者WBC水平高于肥胖者（平均秩次值为52．96比36．46）；吸烟者FBG、CRP高于与非吸烟者（平均秩次值分别为57．75比42．69，53．92比37．75）；累及外周肺动脉者FBG、GRP、ESR水平高于未累及外周肺动脉者（平均秩次值分别为59．24比37．39，52．68比33．19，50．08比36．55）；上述差异均有统计学意义（均P〈0．05）。结论部分临床常用的炎症相关指标在ⅥE患者中升高，且在VrE急性期和亚急性期以及高龄、非肥胖、吸烟、累及外周肺动脉的VTE患者中较明显。

Objective To evaluate the dynamic changes of inflammation-related indices in blood during the development of venous thromhoembolism （VTE） and the association between these indices and VTE. Methods A total of 95 VTE hospitalized patients （41 males, 54 females ） were recruited from Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital from January 2010 toDecember 2010. Comparisons of inflammation-related indices including white blood cell （WBC）, neutrophil （ NE）, fibrinogen （ FBG）, C-reactive protein （CRP） and erythrocyte sedimentation rate （ESR） were conducted between VTE patients and normal ranges. And the dynamic changes of these indices during the development of VTE were evaluated. Then they were divided into subgroups according to disease stage, gender, age, VTE type, body mass index, smoking status and clinical manifestations. And statistical analyses were performed to elucidate the associations between these indices and VTE. Results The levels of NE and CRP in VTE patients （0. 72, 15.0 mg/L） and ESR in male VTE patients （20. 0 mm/1 h） were elevated compared with normal ranges; while WBC （ male 7.27 x 109/L, female 8.67 x 109/L） , FBG （male 3621 mg/L, female 3201 mg/L） and female ESR （19. 5 ram/1 h） in VTE patients were within the normal ranges. The level of CRP was higher in acute （ mean rank order value ： 49.72） and sub-acute （ mean rank order value： 44. 80） VTE patients than chronic VTE patients （mean rank order value： 30. 25 ）. The level of FBG, CRP and ESR in patients t〉50 years old increased versus those 〈 50 years old （mean rank order values 48.83 vs 34. 53,44.32 vs 28.90 and 45.95 vs 27.84 respectively） , the patients whose body mass index （BMI） 〈25 kg/m2 had higher WBC level than those whose BMI I〉25 kg/m2（mean rank order values 52. 96 vs 36. 46） ; smoking VTE patients had elevated FBG and CRP levels than non-smoking VTE patients （mean rank order values 57. 75 vs 42. 69 and 53.92 vs 37. 75 respectively） ; compared with those without clinical manifestations of periphery pulmonary artery involved, the patients with clinical manifestations had higher levels of FBG, CRP and ESR （ mean rank order values 59. 24 vs 37. 39, 52. 68 vs 33.19 and 50. 08 vs 36. 55 respectively）. The above differences had statistical significance （ all P 〈 0. 05 ）. Conclusions Some inflammation-related indices frequently used in clinical settings become elevated in VTE patients. Part of these indices show higher levels in VTE acute and sub-acnte stages, and in older, nonobese, smoking and periphery pulmonary artery involved VTE patients.