下肢深静脉血栓患者非高危肺栓塞危险的多因素分析

Multivariate analysis of risk stratification in patients of non-high risk pulmonary embolism caused by lower extremity deep venous thrombosis

目的：探讨下肢深静脉血栓（DVT）引起非高危肺栓塞（PE）危险分层的预测因素。方法：回顾性分析85例DVT引起非高危PE患者的临床资料，通过CTA图像计算CT阻塞指数（CTOI）值及右左心室直径比值（RV／LV），以Logitic回归分析来探求影响非高危PE危险分层的预测因素。结果：平均CTOI为（22．9±15．7）％，RV／LV为1．0±0．2；低危PE者44例（51．8％），中危PE者41例（占48．2％）；Logitic回归分析显示是PE症状及CTOI是非高危PE的预测因素（OR：10．012、1．184；P=0．012、0．000：95％CI：1．673-59．913、1．101-1．274），而RV，LV（OR：0．149；P=0．436；95％CI：0．001～17．913）、年龄（OR：1．028；P=0．344；95％CI：0．971～1．089）、性别（OR：2．976；P=0．231；95％CI：0．500～17．727）、下肢DVT类型（OR：0．576；P=0．468；95％CI：0．130～2．555）、患病肢体（OR：0．499；P=0．199；95％CI：0．173～1．440）不是其危险因素。结论：对于DVT引起的非高危PE来讲．PE出现症状及CTOI值升高是PE危险分层高的主要预测因素。

Objective： To determine the predictors of risk stratification in non-high risk pulmonary embolism （PE） patients caused by lower extremity deep venous thrombosis（DVT）. Methods： Clinical data of total 85 non-high risk PE patients caused by DVT were retrospectively analyzed. CT obstruction index （CTOI） and right-to-left ventricular diameter ratio （RV/LV） were calculated with pulmonary arterial CT angiography （CTA） images. Logistic regression models were used to identify predictors of PE risk stratification. Results： The mean CTOI was 22.9%±15.7%, and the mean RV/LV was 1.0±0.2. Forty-four（51.8%） pa- tients had low risk PE and 41（48.2%） patients had median risk PE. Logistic regression analysis showed that PE symptoms and CTOI were predictors of PE risk stratification （OR： 0.149; P=0.436; P=0.012, 0.000; 95% CI： 1.673-59.913, 1.101-1.274）, and RV/LV（OR 0.149, P=0.436, 95% CI： 0.001-17.913）, age（OR 1.028, P=0.344, 95% CI： 0.971-1.089）, sex（OR 2.976, P=0.231, 95% CI： 0.500-17.727）, type of DVT （OR 0.576, P=0.468, 95% CI： 0.130~2.555） or laterality of DVT （OR 0.499, P=0.199, 95% CI： 0.173-1.440） were not predictors. Conclusion： In non-high risk PE patients caused by DVT, PE symptoms and higher CTOI value are major predictors of higher PE risk stratification.