妇科疾病患者发生症状性下肢深静脉血栓和症状性肺栓塞的临床对比分析

Comparison of clinical data of gynecological patients with symptomatic deep vein thrombosis only,pulmonary embolism only and pulmonary embolism plus deep vein thrombosis

目的寻找妇科疾病患者从深静脉血栓进展为肺栓塞的高危因素,识别可能直接发生肺栓塞的高危患者并及时加以预防,在避免过度治疗的同时降低肺栓塞的发生。方法复习单纯深静脉血栓、单纯肺栓塞以及深静脉血栓合并肺栓塞的妇科患者的临床资料。结果从2000年1月1日至2012年10月31日,共有87 587名妇科疾病患者住院。其中0.43‰发生深静脉血栓(深静脉血栓组38例),0.18‰发生肺栓塞(肺栓塞组16例),0.21‰发生深静脉血栓合并肺栓塞(深静脉血栓合并肺栓塞组18例)。3组之间,血清纤维蛋白原水平具有显著性差异(P=0.007)。肺栓塞组和深静脉合并肺栓塞组中,67.7%的患者疾病原发于卵巢、输卵管或腹膜。在深静脉血栓组,65.8%的患者疾病原发于子宫、阴道和外阴(P=0.009)。双下肢深静脉血栓更易触发肺栓塞(P=0.015)。多元回归分析显示,疾病原发灶位于卵巢/输卵管/腹膜(P=0.004,OR=3.985),体重指数>25.0kg/m2(P=0.018,OR=1.239),和双侧深静脉血栓(P=0.017,OR=6.81)的患者更容易发生肺栓塞。凝血酶时间值越低,越容易术前发生血栓(P=0.004,OR=2.416)。结论原发疾病位于卵巢/输卵管/腹膜、体重指数>25.0kg/m2或者双侧深静脉血栓是深静脉血栓基础上发生肺栓塞,或者直接发生肺栓塞的危险因素。

To explore the risk factors of progression from deep venous thrombosis to pulmonary embolism. Methods： The clinical data of gynecological patients suffered pulmonary embolism and/or deep venous thrombosis were reviewed. Results： A total of 87,587 patients were hospitalized in Department of Obstetrics and Gynecology of Peking Union Medical College Hospital. Among them,the incidence of deep venous thrombosis was 0.43%0 （38 patients）, pulmonary embolism 0.18%0 （16 patients）, and deep venous thrombosis plus pulmonary embolism 0.21%0（18 patients）. The fibrinogen level was significantly different among the three groups （P=0. 007）. Comparison the patients suffered pulmonary embolism, deep venous thrombosis, or deep venous thrombosis plus pulmonary embolism before surgery or after surgery showed significant differences in terms of gravidity（P=0. 031） ,body mass index（P=0. 018） ,and thrombin time（P=0.001）. 67.6% of patients suffered pulmonary embolism with/without deep venous thrombosis had a primary lesion in the ovary,fallopian tube,or peritoneum. In contrast, the primary sites of 65.8% patients mainly located at uterus, vagina, and vulva（P = 0. 009）in the deep venous thrombosis patients. Compared with unilateral deep venous thrombosis, bilateral deep venous thrombosis was more likely to trigger pulmonary embolism （P= 0. 015）. Logistic regression analysis showed patients with a primary lesion in the ovary,fallopian tube, or peritoneum （P = 0. 004, OR = 3. 985） ; BMI of〉 25.0 kg/m2 （P = 0. 018, OR = 1. 239） ; or bilateral deep venous thrombosis（P= 0. 017 ,OR= 6.81）were more likely to develop pulmonary embolism. Conclusions： The primary lesion located in the ovary/fallopian tube/peritoneum, BMI〉25.0 kg/m2, and bilateral deep venous thrombosis are the high risk factors of pulmonary embolism.