慢性阻塞性肺疾病合并肺血栓栓塞症的临床特征分析

Retrospective analysis of clinical features of chronic obstructive pulmonary disease complicated with pulmonary thromboembolism

目的分析慢性阻塞性肺疾病(COPD)合并肺血栓栓塞症(PTE)患者的临床特征.方法回顾性分析太原市中心医院2015年6月至2018年3月收治的COPD合并PTE患者21例与COPD急性加重期(AECOPD)患者26例的临床资料,采用SPSS 22.0统计软件对两组的一般资料、血气分析结果、肺功能、血红蛋白、凝血指标、合并疾病进行分析.结果 COPD合并PTE组与AECOPD组年龄、性别、肺功能分级差异均无统计学意义(均P>0.05).COPD合并PTE组胸痛(8例,38.1%)、晕厥(2例,10.5%)发生比例均高于AECOPD组[胸痛(3例,11.5%)、晕厥(1例,3.8%)](x2=7.645、9.413,均P<0.05).两组二氧化碳分压(PaCO2)差异无统计学意义(P>0.05);COPD合并PTE组血氧分压(PaO2)为(62.86±15.10) mmHg,低于AECOPD组的(74.83±17.59) mmHg(t=4.642,P<0.05);COPD合并PT组血红蛋白、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体分别为(146.78±21.40) g/L、(35.62±5.93)s、(4.34±1.18) g/L、(5.02±3.63) mg/L,均高于AECOPD组的(137.45±15.15) g/L、(29.38±3.16)s、(3.62±1.08)g/L、(0.92±0.42) mg/L(t=4.375、4.654、3.869、18.653,均P<0.05).两组糖尿病、高血压、高脂血症、下肢血静脉曲张等合并症比例差异均无统计学意义(均P >0.05).结论 COPD合并PTE患者有以下特点:高龄,男性患者占比高,胸痛、晕厥症状发生比例高,缺氧程度较重,血红蛋白、D-二聚体明显增高.

Objective To analyze the clinical features of patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary thromboembolism ( PTE). Methods The clinical data of 21 patients with COPD and PTE and 26 patients with acute exacerbation of COPD ( AECOPD) from June 2015 to March 2018 in Taiyuan Central Hospital were retrospectively analyzed. The SSPS 22. 0 statistical software was used to analyze the clinical data. General data, blood gas analysis results, lung function, hemoglobin, coagulation parameters, combined disease were analyzed. Results There were no statistically significant differences in age, gender and lung function grading between the COPD complicated with PTE group and AECOPD group ( all P > 0. 05 ). The incidence rates of chest pain(8 cases,38. 1%) and syncope(2 cases, 10. 5%) in the COPD complicated with PTE group were higher than those in the AECOPD group [ chest pain (3 cases ,11. 5%), syncope(1 case,3. 8%)](X2 = 7. 645,9. 413 , all P < 0. 05). There was no statistically significant difference in carbon dioxide partial pressure ( PaCO2 ) retention between the two groups(P > 0. 05 ). The blood oxygen partial pressure ( PaO2 ) of the COPD complicated with PTE group was (62. 86 ± 15. 10) mmHg,which was lower than that of the AECOPD group [(74. 83 ± 17. 59) mmHg](i = 4. 642,P<0. 05 ). The hemoglobin,activated partial thromboplastin time( APTT), fibrinogen ( FIB), D - dimer levels in the COPD complicated with PTE group were ( 146. 78 ± 21.40) g/L,( 35. 62 ± 5. 93) s,(4. 34 ± 1. 18 ) g/L,(5. 02 ± 3. 63 ) mg/L, respectively, which were higher than those in the AECOPD group [( 137. 45 ± 15. 15 ) g/L,(29. 38 ±3.16)s,(3.62±1.08)g/L,(0.92 ±0.42)mg/L](t =4. 375,4.654,3. 869,18.653,all P <0.05). There were no statistically significant differences in the proportion of comorbidities such as diabetes, hypertension, hyperlipidemia and lower extremity ( all P > 0. 05 ). Conclusion COPD patients complicated with PTE have the following characteristics: elderly and male patients accounted for a high proportion, chest pain and syncope symptoms occurred in a high proportion, severe hypoxia, hemoglobin and D - dimer increased significantly.