下肢深静脉血栓发生无症状性肺栓塞的相关危险因素分析

Risk factors associated with the occurrence of silent pulmonary embolism in patients with deep venous thrombosis

目的探讨下肢深静脉血栓（DVT）患者无症状性肺栓塞（PE）的发生率及相关危险因素。方法收集2009—2013年入住血管外科的急性下肢深静脉血栓患者共203例,所有患者均完成计算机断层扫描肺动脉造影（CTPA）。并根据结果分为发生无症状性PE组和未发生无症状性PE组,利用卡方检验分析比较两组间临床资料的差异,通过多因素Logistic回归分析发生无症状性PE的相关危险因素。结果 203例DVT患者中64例发生无症状性PE（31.5%）,通过单因素分析发现,下肢深静脉血栓部位、DVT患肢、既往DVT病史、是否合并心脏疾病与无症状性PE的发生显著相关（P〈0.01）；通过多因素Logistic回归分析显示,下肢深静脉血栓为中央型（OR=0.158；95%CI,0.063～0.393；P〈0.01）、DVT位于右下肢（OR=3.632；95%CI,1.004～13.138；P=0.045）、既往无DVT病史（OR=0.179；95%CI,0.046～0.704；P=0.014）、合并存在心脏疾病（OR=4.063；95%CI,1.107～14.918；P=0.035）是DVT患者发生无症状性PE的危险因素。结论无症状性PE在急性DVT患者中具有较高的发生率,且下肢深静脉血栓为中央型、DVT位于右下肢、既往有DVT病史及合并存在心脏疾病可增加发生无症状性PE的风险。

Objective To investigate the prevalence of silent pulmonary embolism in patients with deep venous thrombosis in the lower limbs,and to evaluate the associated risk factors. Methods A total of 203 patients with acute deep venous thrombosis was retrieved as subjects. All patients completed computed tomography pulmonary arteriography and were assigned into silent PE group and non silent PE groups. The association between covariates and the prevalence of silent pulmonary embolism in patients with deep venous thrombosis in lower limbs were assessed using chi-square test and multivariable Logistic regression analysis. Results Of 203 patients with deep venous thrombosis in lower limbs 64 patients had silent pulmonary embolism（31. 5%）. Univariate analysis indicated that position of deep venous thrombosis,DVT limb,previous DVT history,coexisting heart diseases were significantly associated with silent pulmonary embolism（ P 〈 0. 01）. Multivariate Logistic regression analysis showed that the central type of deep venous thrombosis（ OR = 0. 158; 95% CI,0. 063 ～ 0. 393;P 0. 01）,the right leg（ OR = 3. 632;95% CI,1. 004 ～ 13. 138;P = 0. 045）,no previous history of deep venous thrombosis（ OR = 0. 179;95% CI,0. 046 ～ 0. 704;P = 0. 014）,coexisting heart diseases（ OR = 4. 063;95% CI,1. 107 ～ 14. 918;P = 0. 035） were risk factors for silent pulmonary embolism. Conclusions Silent pulmonary embolism occurs frequently in patients with acute deep venous thrombosis in lower limbs. And central type of deep venous thrombosis,the right leg,no previous history of deep venous thrombosis and coexisting heart diseases increase the risk for the occurrence of silent pulmonary embolism.