肺栓塞并胸腔积液的相关临床分析

Clinical relevance of pleural effusion in patients with pulmonary embolism

目的探讨肺栓塞(Pulmonary Embolism,PE)并胸腔积液患者的临床特点。方法对确诊的115例肺栓塞患者,根据患者是否存在胸腔积液分为肺栓塞并胸腔积液组(实验组)及肺栓塞无胸腔积液组(对照组),比较两组的临床特点。结果合并胸腔积液有52例,无胸腔积液有63例。肺栓塞并胸腔积液患者的发热比率、呼吸次数、PT、APTT、FIB、INR、DD、HSCRP、cTnT、NTproBNP、RAD及mPAP高于无胸腔积液患者,差异有统计学意义(P<0.05);肺栓塞并胸腔积液患者的LYMPH、AT水平低于无胸腔积液患者,差异有统计学意义(P<0.05);经多因素logistic回归分析,FIB、DD、RAD及AT可能是PE发生胸腔积液独立预测因子,FIB、DD及RAD可能是PE患者发生胸腔积液的危险因素,AT可能为PE发生胸腔积液的保护因素。52例肺栓塞合并胸腔积液患者中,双侧胸腔积液33例(63.5%),单侧胸腔积液19例(36.5%);少量胸腔积液44例(84.6%),中-大量胸腔积液8例(15.4%);双侧少量胸腔积液29例(55.77%)。肺栓塞栓塞部位与是否发生胸腔积液比较,差异无统计学意义(P>0.05)。在肺栓塞并胸腔积液组中,肺栓塞栓塞部位与胸腔积液部位比较,差异无统计学意义(P>0.05);肺栓塞栓塞部位与胸腔积液量比较,差异无统计学意义(P>0.05);胸腔积液部位与胸腔积液量比较,差异无统计学意义(P>0.05)。肺栓塞并胸腔积液组不良事件发生率高于肺栓塞无胸腔积液组,差异有统计学意义(P<0.05)。结论FIB、DD、RAD及AT可能是PE发生胸腔积液的影响因素。肺栓塞并胸腔积液多为双侧少量胸腔积液。肺栓塞部位、胸腔积液量及胸腔积液部位之间未发现有相关性。胸腔积液对PE患者短期预后的评估具有一定价值。

Objective To investigate the clinical characteristics of PE patients with pleural effusion caused by PE.Methods 115 patients with acute pulmonary embolism were retrospectively analyzed and divided into 2 groups based on computed tomography:the group with pleural effusion due to PE(the effusion group)and the group without pleural effusion(the control group).Their clinical characteristics were compared between the two groups.Results The study population consisted of the effusion group(n=52)and the control group(n=63).The levels of LYMPH and AT were significantly lower in the effusion group than in the control group.Based on student's test results,the multivariate logistic-regression analysis was performed to search influencing factors for the occurrence of pleural effusions in PE patients.The significantly relevant factors were FIB,DD,RAD and AT.FIB,DD and RAD might be independent risk factors for the development of pleural effusion,and AT might be protective factor for the development of pleural effusion.Of the 52 patients with pleural effusion,bilateral pleural effusion was detected in 33 patients(63.5%),unilateral pleural effusion was detected in 19 patients(36.5%),small pleural effusion was detected in 44 patients(84.6%),and medium-large pleural effusion were detected in 8 patients(15.4%).Bilateral and small pleural effusions were detected in 29 patients(55.77%).Compared with the two group,there was no significant difference between the site of pulmonary embolism and the occurrence of pleural effusion(P>0.05).In the effusion group,there was no significant difference between the site of pulmonary embolism and the site of the pleural effusion.There was no significant difference between the site of pulmonary embolism and pleural effusion amount.There was no significant difference between pleural effusion amount and the site of the pleural effusion.The frequencies of adverse events were significantly higher in the effusion group than in the control group.Conclusion The levels of FIB,DD,RAD and AT may be the influencing factors of pleural effusions in PE patients.The pleural effusion are mostly bilateral and small pleural effusions.There is no significant correlation among the side of pleural effusion,the amount of pleural effusion and location of thrombus.Pleural effusion has certain evaluation value for short-term outcome.