不同危险分层肺血栓栓塞患者的影响因素、临床表现及血脂水平研究

Clinical Manifestations and Serum Lipid Levels of Patients with Pulmonary Thromboembolism in Different Risk Stratification and the Influencing Factors of Risk Stratification

目的探讨肺血栓栓塞(PTE)患者危险分层的影响因素以及不同危险分层PTE患者的临床表现及血脂水平,为临床PTE危险分层和制定合理治疗方案提供依据。方法选取2010—2014年中国医科大学附属盛京医院收治的PTE患者60例,依据2014年欧洲心脏病学会(ESC)制定的《急性肺栓塞诊断及管理指南》中提出的PTE的危险分层标准,将纳入患者分为高/中危组(n=35)和低危组(n=25)。收集两组患者的临床资料,比较两组患者的基本情况、临床表现及血脂水平,采用多因素Logistic回归分析探讨PTE危险分层的影响因素。结果两组患者年龄比较,差异有统计学意义(P<0.05);男性比例及吸烟、饮酒、高血压、冠心病、糖尿病、脑血管疾病、下肢深静脉血栓(DVT)、近期手术、创伤、长期卧床史比较,差异均无统计学意义(P>0.05)。年龄是PTE危险分层的影响因素[OR=1.145,95%CI(1.059,1.238),P<0.05]。两组心悸、咯血或痰中带血、晕厥、濒死感发生率比较,差异有统计学意义(P<0.05);呼吸困难、咳嗽、胸痛、三联征发生率比较,差异无统计学意义(P>0.05)。两组心动过速、颈静脉充盈发生率比较,差异有统计学意义(P<0.05);下肢肿胀、体温升高、呼吸急促、湿啰音、发绀、第二心音亢进、哮鸣音发生率比较,差异无统计学意义(P>0.05)。两组患者血清总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、载脂蛋白AⅠ、载脂蛋白B水平比较,差异均无统计学意义(P>0.05)。结论高龄是发生高/中危PTE的危险因素。若PTE患者存在心悸、晕厥、濒死感、心动过速及颈静脉充盈等临床症状及体征,临床中需要警惕高/中危PTE的发生。

Objective To explore the clinical manifestations and serum lipid levels of patients with pulmonary thromboembolism （PTE） in different risk stratification and the influencing factors of risk stratification, in order to provide a rational treatment plan and preliminary diagnostic evidence for different risk stratified PTE. Methods A total of 60 patients with PTE were enrolled from 2010 to 2014 in Shengjing Hospital of China Medical University in this study. According to the PTE risk classification standards proposed in the Guidelines on Diagnosis and Management of Acute Pulmonary Embolism which was developed by the European Society of Cardiology （ESC） in 2014, PTE patients were divided into high/medium risk PTE group （ n = 35 ） and low risk PTE group （ n = 25 ） . The clinical data of two groups such as baseline information, clinical manifestations and serum lipid levels were collected and the baseline information was statistically analyzed through multivariate Logistic regression to explore the influencing factors of risk stratification. Results The difference of age between two groups was statistically significant （P 〈0. 05 ） . There were no significant differences in the proportion of male, smoking, alcohol consumption, hypertension, coronary heart disease, diabetes mellitus, cerebrovascular disease, deep venous lhrombosis （DVT）, recent surgery, trauma and long - term bed rest between two groups （P 〉0. 05） . Age is the influencing/＇actor of PTE risk stratification OR = 1. 145, 95% CI （ 1. 059, 1. 238 ） , P 〈 0. 05 1. There were significant differences in the incidence of palpitations, hemoptysis or blood - stained sputum, syncope and feeling impending death between two groups （ P 〈 0. 05 ）. There were no significant differences in the incidence of dyspnea, cough, chest pain and triple syndromes between two groups （P 〉 0.05 ）. There were statistically significant differences in the incidence of tachycardia and jugular vein distension between two groups （ P 〈 0. 05）. There were no significant differences in the incidence of lower extremity swelling, fervescence, shortness of breath, moist rale, cyanosis, accentuation of second heart sound and wheeze between two groups （P 〉 0. 05）. There were no significant differences in levels of serum total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, apolipoprotein A I and apolipoprotein B between two groups （P 〉0. 05） . Conclusion Advanced age is the risk factor of high/ medium risk of PTE. When PTE patients develop the clinical symptoms such as palpitations, syncope, feeling impending death, tachycardia, jugular vein distension and so on, the onset of high/medium risk of PTE should be forecasted.