肺栓塞患者血栓定位与伴随疾病、危险因素、D二聚体、红细胞分布宽度的关系

Correlation between thrombus location and concomitant diseases, risk factors, D-dimer, red blood cell distribution width in patients with pulmonary embolism

目的明确肺栓塞(PE)患者血栓定位与伴随疾病、危险因素、D二聚体、红细胞分布宽度(RDW)的关系。方法 148例已确诊的肺栓塞患者,通过肺动脉CT血管造影技术(CTPA)评估血栓的存在和结构定位,分析血栓定位与伴随疾病、危险因素、D二聚体、红细胞分布宽度的关系。结果 148例患者中,血栓定位于右肺主动脉的患者有56例(37.8%),定位于左肺主动脉的患者有26例(17.6%),定位于双侧肺主动脉的患者有66例(44.6%)。不同血栓定位患者的性别、恶性肿瘤、近期手术情况比较,差异具有统计学意义(P<0.05)。使用CTPA技术发现血栓定位于主肺动脉的患者有46例(31.1%),血栓定位于肺叶、节段或亚段血管动脉的患者有102例(68.9%)。主肺动脉及肺叶、节段或亚段血管动脉栓塞患者的固定、近期手术、D二聚体、红细胞分布宽度情况比较,差异具有统计学意义(P<0.05)。主肺动脉栓塞红细胞分布宽度的ROC曲线下面积为0.72, 95%置信区间为(0.63, 0.81)。无主肺动脉栓塞红细胞分布宽度截断值为15.25%,该截断值展示的敏感性为69.6%,特异性为62.7%。结论血栓定位与手术固定、D二聚体水平、红细胞分布宽度具有显著相关性。

Objective To investigate the correlation between thrombus location and concomitant diseases, risk factors, D-dimer, red blood cell distribution width(RDW) in patients with pulmonary embolism(PE). Methods There were 148 patients diagnosed with pulmonary embolism, and the presence and anatomical localization of the thrombus were assessed via CT pulmonary angiography. The correlation between thrombus location and concomitant diseases, risk factors, D-dimer, red blood cell distribution width was analyzed. Results Of the 148 patients, thrombus of 56 patients(37.8%) were located in the right pulmonary aorta, 26 patients(17.6%) in the left pulmonary aorta, and 66 patients(44.6%) in the bilateral pulmonary aorta. There was statistically significant difference in gender, malignant tumor and recent surgery of patients with different thrombus locations (P<0.05). Using CTPA technique, 46 patients(31.1%) with thrombus localized to the main pulmonary artery, and 102 patients(68.9%) with thrombus to the pulmonary lobe, segment, or sub-segment vascular artery. There were statistically significant differences in fixation, recent surgery, D-dimer and red blood cell distribution width in patients with thrombus localized to main pulmonary artery and pulmonary lobe, segment or sub-segmental vascular artery(P< 0.05). The area under the ROC curve of the distribution width of red blood cells without thrombus localized to main pulmonary artery was 0.72, and the 95% confidence interval was(0.63, 0.81). The cut-off value of the distribution width of red blood cells without thrombus localized to main pulmonary artery was 15.25%. The cut-off value showed a sensitivity of 69.6% and a specificity of 62.7%. Conclusion The thrombus location was significantly correlated with surgical fixation, D-dimer level and red blood cell distribution width.