血浆D-二聚体水平与慢性阻塞性肺疾病急性加重期相关性胸腔积液关系的研究

ASSOCIATION BETWEEN PLASMA D-DIMER AND PLEURAL EFFUSION RELATED TO AECOPD

目的:探讨血浆D-二聚体水平与慢性阻塞性肺疾病急性加重期(AECOPD)相关性胸腔积液之间的关系。方法:71例研究对象分为A组(AECOPD合并胸腔积液组)27例,B组(单纯AECOPD组)31例及C组(非COPD组,对照组)13例,并将A组随机分为A1组13例及A2组14例,所有入选AECOPD患者均按照COPD诊治指南治疗,A1组在规范治疗方案基础上加用低分子肝素钙治疗。观察治疗前后血浆D-二聚体及胸腔积液量。结果:①D-二聚体水平:治疗前A1组及A2组血浆D-二聚体水平均明显高于B组(P<0.05),而A、B组均明显高于C组(P<0.05);治疗1周后A1组D-二聚体水平较A2组、B组下降(P<0.05),2周后与C组对比,无明显差异(P>0.05),而A2组、B组D-二聚体水平下降缓慢,4周后与C组对比,无明显差异(P>0.05)。②胸腔积液量:治疗前A1、A2组之间胸腔积液量无明显差异(P>0.05);治疗2周后两组患者胸腔积液量均减少(P<0.05),而A1组胸腔积液量少于A2组(P<0.05);治疗4周后A1组所有患者胸腔积液全部吸收,而A2组仍有5例患者存在少量胸腔积液(P<0.05)。③胸腔积液量与血浆D-二聚体呈正相关(r=0.607,P<0.05)。结论:AE-COPD相关性胸腔积液的发病可能与肺循环高凝状态有关。使用低分子肝素钙治疗可加快AECOPD相关性胸腔积液的吸收。

Objective：To explore the association between plasma D-dimer and pleural effusion related to acute exacerbation chronic obstruction pulmonary disease （AECOPD）. Methods： Seventy one patients were divided into AECOPD with pleural effusion group （group A, n =27）, AECOPD without pleural effusion group （group B, n ：31） and control group （groupC, n=13）. Group A were randomly divided into group A1 （ n =13） and group A2 （ n =14）. All AECOPD patients were treated with conventional therapy based on GOLD. In group A1 ,patients were subcutaneous injected a dose of low molecular weight heparin calcium once a day for 7 days. The concentrations of plasma D-dimer in peripheral blood were detected and chest CT was assessed in patients before and after treatment. Results： ①Plasma D-dimer： The concentra tion of plasma D-dimer was higher in group A （there was no difference between groups A1 and A2, P 0.05） than in group B （ P〈0.05）, and was higher in group B than in group C （ P〈0.05）. The concentration of plasma D-dimer was decreased in group A1 as compared with group A2 after one week＇s therapy （ P〈0.05）, and there was no difference in plasma D-dimer between groups A1 and C at 2 weeks （ P〉0.05）. There were no differences in plasma D-dimer among groups A, B and C at 4 weeks （ P〉0.05）. ② Pleural effusion quantity： Before therapy, there was no difference on pleural effusion quantity between groups A1 and A2 （ P〉0. 05）. The pleural effusion quantity was decreased in group A1 as compared with group A2 （ P〈0.05） at 2 weeks and fully absorption at 4 weeks, while in group A2, the pleural effusion absorption was slow, and there were still five patients with small pleural effusion quantity at 4 weeks.③There was positively correlated between plasma D dimer and pleural effusion quantity （ P 〈0.05）. Conclusion： There was hypercoagulable state in patients with AECOPD and might lead to the pleural effusion. Treatment with low molecular heparin calcium might promote absorption of pleuraI effusion related to AECOPD.