CT血管成像评估髂静脉压迫综合征并急性髂股静脉血栓患者肺栓塞的风险

CT angiography in the evaluation of the risk of pulmonary embolism in patients with iliac vein compression syndrome and acute iliofemoral vein thrombosis

目的基于肺动脉联合下腔静脉CT血管成像技术,评估髂静脉压迫综合征(IVCS)并急性髂股静脉血栓患者的肺栓塞风险及其影响因素。方法回顾性分析2016年7月至2020年6月在济宁医学院附属医院确诊的166例急性左髂股静脉血栓患者的资料。所有患者均接受“一站式”肺动脉联合下腔静脉CT血管成像。按有无IVCS分为IVCS组(101例)和无IVCS组(65)例,比较2组患者一般资料,左髂总静脉狭窄率,下腔静脉漂浮血栓、盆腔粗大侧支静脉、肺栓塞发生情况,肺动脉栓塞指数,并采用多因素logistic回归及多元线性回归分析IVCS组肺栓塞发生率及其严重程度的影响因素。结果IVCS组与无IVCS组左髂总静脉狭窄率[分别为(68±8)%、(25±14)%,t=-25.300,P<0.001]、下腔静脉漂浮血栓的发生情况[分别为25/101、31/65,χ^(2)=9.310,P=0.002]、下腔静脉漂浮血栓长度[分别为17.2(10.9,27.8)mm,27.4(20.1,55.9)mm,Z=-2.316,P=0.021]、肺栓塞发生情况(分别为43/101、41/65,χ^(2)=6.651,P=0.010)、肺动脉栓塞指数[分别为10.0%(5.0%,17.5%)、22.5%(10.0%,30.0%),Z=-3.490,P<0.001]差异均有统计学意义。IVCS组中,多因素logistic回归分析显示左髂总静脉狭窄率[β=-1.964,OR(95%CI)0.140(0.031~0.638),P=0.011]、下腔静脉漂浮血栓[β=1.212,OR(95%CI)3.360(1.566~7.209),P=0.002]是肺栓塞发生的独立影响因素;多元线性回归分析显示下腔静脉漂浮血栓对肺动脉栓塞指数的影响具有统计学意义(b=0.352,t=2.410,P=0.021)。结论IVCS并急性左侧髂股静脉血栓患者肺栓塞的发生率和严重程度均低于无IVCS患者,有无下腔静脉漂浮血栓是影响肺栓塞严重程度的重要因素。

Objective To evaluate the risk and influencing factors of pulmonary embolism in patients with iliac vein compression syndrome(IVCS)and acute iliofemoral vein thrombosis by CT pulmonary angiography combined with CT venography of inferior vena cava.Methods The data of 166 patients with acute left iliofemoral vein thrombosis diagnosed in the Affiliated Hospital of Jining Medical University from July 2016 to June 2020 were analyzed retrospectively.All patients underwent one-stop CT pulmonary angiography combined with inferior vena cava CT venography.The patients were divided into IVCS group(101 cases)and non-IVCS group(65 cases)according to the presence or absence of IVCS.The general data of the patients,the stenosis rate of left common iliac vein,the presence of inferior vena cava floating thrombosis,the presence of large pelvic collateral veins,the detection of pulmonary embolism and the pulmonary artery obstruction index of the two groups were compared,and multivariate logistic regression and multiple linear regression were used to analyze the influencing factors of the incidence and severity of pulmonary embolism in IVCS group.Results There were significant differences in the stenosis rate of left common iliac vein[(68±8)%vs(25±14)%,t=-25.300,P<0.001],the incidence of inferior vena cava floating thrombosis[25/101,31/65,χ^(2)=9.310,P=0.002],the length of inferior vena cava floating thrombosis[17.2(10.9,27.8)mm vs 27.4(20.1,55.9)mm,Z=-2.316,P=0.021],the incidence of pulmonary embolism(43/101 vs 41/65,χ^(2)=6.651,P=0.010)and the pulmonary artery obstruction index[10.0%(5.0%,17.5%)vs 22.5%(10.0%,30.0%),Z=-3.490,P<0.001]between IVCS group and non-IVCS group.In the IVCS group,multiple logistic regression analysis revealed that the stenosis rate of left common iliac vein[β=-1.964,OR(95%CI)0.140(0.031-0.638),P=0.011]and inferior vena cava floating thrombosis[β=1.212,OR(95%CI)3.360(1.566-7.209),P=0.002]was independent factors for the occurrence of pulmonary embolism.Multiple linear regression showed that the influence of inferior vena cava floating thrombosis on the pulmonary artery obstruction index was statistically significant(b=0.352,t=2.410,P=0.021).Conclusion The incidence and severity of pulmonary embolism in patients with IVCS and acute left iliofemoral vein thrombosis are lower than those without IVCS,and the presence or absence of inferior vena cava floating thrombosis is an important factor affecting the severity of pulmonary embolism.