急性下肢深静脉血栓形成后肺栓塞严重程度的危险因素分析

Risk factors associated with the severity of pulmonary embolism in patients with acute deep venous thrombosis of lower extremities

目的 探讨急性下肢深静脉血栓形成患者肺栓塞严重程度的危险因素.方法 本研究为前瞻性研究.2010年7月至2012年7月收集首都医科大学附属北京世纪坛医院血管外科诊断的急性下肢深静脉血栓形成的患者资料,其中符合纳入、排除标准的208例患者纳入本研究.其中男性101例,女性107例,平均年龄（59±16）岁.利用肺动脉CT血管造影、肺动脉磁共振血管造影或肺动脉数字减影血管造影筛查肺栓塞,并评估其肺栓塞程度.采用χ^2检验和Logistic回归对深静脉血栓形成患者发生肺栓塞程度的危险因素进行单因素和多因素分析.结果 208例下肢深静脉血栓形成患者中70例发生肺栓塞,总体发生率为33.7％.单因素分析结果显示,下肢深静脉血栓范围（χ^2=17.286,P=0.004）、下肢深静脉血栓部位（χ^2=15 602,P=0.008）对肺栓塞的严重程度有影响.年龄（χ^2=7.099,P=0.260）、性别（χ^2=7.014,P=0.067）、明显血栓危险因素（χ^2=3.335,P=0.345）对肺栓塞的严重程度无影响.多因素有序Logistic回归分析显示肺栓塞的程度随着下肢深静脉血栓范围的扩大和部位的增加而加重,髂股静脉血栓（OR =6.172,95％ CI：1.590 ～ 23.975,P=0.009）、双下肢深静脉血栓（OR=7.140,95％ CI：2.406 ～ 24.730,P=0.001）是肺栓塞严重程度的独立危险因素.结论 髂股静脉血栓形成、双侧下肢深静脉血栓形成是发生严重肺栓塞的独立危险因素,对这些高危患者应更加注重肺栓塞的防治.

Objective To identify the risk factors associated with the severity of pulmonary embolism among patients with deep venous thrombosis of lower extremities.Methods This prospective study enrolled 208 patients with acute deep venous thrombosis to screen for pulmonary embolism between July 2010 and July 2012 in Beijing Shijitan Hospital.There were 101 male and 107 female patients,with a mean age of （59 ± 16） years.Gender,age,extension,side of lower extremities of deep venous thrombosis was analyzed by χ^2 test.Ordinal Logistic regression was used to determine risk factors associated with severity of pulmonary embolism.Results There were 83 patients with iliofemoral deep venous thrombosis,102 patients with femoropopliteal and 23 patients with calf deep venous thrombosis.Pulmonary embolism was detected in 70 patients with the incidence of 33.7%.Pulmonary embolism was significantly correlated with extension （χ^2 =17.286,P =0.004） and sides （χ^2 =15.602,P =0.008） of deep venous thrombosis,not with age （χ^2 =7.099,P=0.260）,gender （χ^2 =7.014,P=0.067）,thrombotic risk factors （χ^2 =3.335,P =0.345） in univariate analysis.Results of multivariate ordinal logistic regression showed that iliofemoral vein thrombosis （OR =6.172,95% CI：1.590 to 23.975,P =0.009） and bilateral venous thrombosis （OR =7.140,95% CI：2.406 to 24.730,P =0.001） are associated with more serious pulmonary embolism.Conclusions Incidence of pulmonary embolism is still high in patients with deep venous thrombosis.Extensive iliofemoral and bilateral vein thrombosis may increase risk of severity of pulmonary embolism.Clinicians should pay more attention to these high-risk patients.