纤维化性间质性肺疾病合并肺栓塞患者临床特点分析

Clinical characteristics of patients with fibrotic interstitial lung disease complicated with pulmonary embolism

目的探究纤维化性间质性肺疾病(FILD)合并肺栓塞患者的临床特点,有助于及早识别此类高危患者,减少误诊及漏诊。方法回顾性收集2002年1月至2022年1月在首都医科大学附属北京安贞医院住院的FILD合并肺栓塞患者29例(观察组),按照性别及年龄匹配的原则以1∶2的比例收集同期住院治疗的单纯FILD患者58例(对照组)。比较2组患者的人口学特征、基础疾病、临床表现、实验室检查以及超声心动图等临床资料。结果观察组结缔组织病患病率高于对照组,差异有统计学意义(P=0.021)。观察组近3个月内应用糖皮质激素比例及长期卧床发生率均高于对照组,差异均有统计学意义(均P<0.05)。2组患者咳嗽、呼吸困难、胸痛、咯血、晕厥发生率比较差异均无统计学意义(均P>0.05)。观察组下肢水肿发生率高于对照组,差异有统计学意义(P=0.039)。观察组B型脑钠肽(BNP)、动脉血pH值、D⁃二聚体水平和肺动脉压力>40 mmHg(1 mmHg=0.133 kPa)、下肢静脉血栓比例均高于对照组,动脉血氧分压低于对照组(均P<0.05)。Logistic多元回归分析结果显示,D⁃二聚体升高(比值比=1.212,95%置信区间:1.201~1.223,P<0.001)、肺动脉压力>40 mmHg(比值比=3.204,95%置信区间:2.240~10.402,P=0.032)、下肢静脉血栓形成(比值比=1.104,95%置信区间:1.101~8.320,P=0.009)与FILD合并肺栓塞风险相关。结论对于FILD患者,如合并结缔组织病、长期应用糖皮质激素、长期卧床者,需要警惕静脉血栓可能。FILD患者如出现下肢水肿、严重肺动脉高压、难以纠正的低氧血症、D⁃二聚体升高、BNP升高、特别是下肢静脉超声提示下肢静脉血栓等情况,提示其合并肺栓塞的可能,应尽早完善相关检查。

Objective To explore the clinical characteristics of patients with fibrotic interstitial lung disease(FILD)complicated with pulmonary embolism(PE),so as to help identify such high⁃risk patients as early as possible and reduce misdiagnosis and missed diagnosis.Methods Totally 29 patients(observation group)with FILD complicated with PE admitted to Beijing Anzhen Hospital,Capital Medical University from January 2002 to January 2022 were retrospectively collected.Fifty⁃eight patients(control group)with simple FILD hospitalized at the same time were collected according to the principle of gender and age matching at a ratio of 1∶2.The demographic characteristics,basic diseases,clinical manifestations,laboratory examinations and echocardiography of the two groups were analyzed.Results The incidence of connective tissue disease in the observation group was higher than that in the control group(P=0.021).The incidences of glucocorticoid use in the past 3 months and long⁃term bed rest in the observation group were higher than those in the control group(both P<0.05).There was no statistically significant difference in the incidence of cough,dyspnea,chest pain,hemoptysis,and syncope between the two groups of patients(all P>0.05).The incidence of lower limb edema in the observation group was higher than that in the control group(P=0.039).Brain natriuretic peptide(BNP),arterial blood pH,D⁃dimer levels,and rates of pulmonary artery pressure>40 mmHg and lower limb venous thrombosis in the observation group were higher than those in the control group,and arterial partial oxygen pressure was lower than that in the control group(all P<0.05).The results of Logistic multiple regression analysis showed that D⁃dimer elevation(odds ratio=1.212,95%confidence interval:1.201⁃1.223,P<0.001),pulmonary artery pressure>40 mmHg(odds ratio=3.204,95%confidence interval:2.240⁃10.402,P=0.032)and lower limb venous thrombosis(odds ratio=1.104,95%confidence interval:1.101⁃8.320,P=0.009)were associated with the risk of FILD complicated with PE.Conclusion Patients with FILD,such as those with connective tissue disease,long⁃term hormone use,and long⁃term bed rest,should be alert to the possibility of venous thrombosis.When patients with FILD have lower limb edema,severe pulmonary hypertension,difficult hypoxemia,D⁃dimer level,BNP level,especially lower limb vein thrombosis indicated by lower limb vein ultrasound,it indicates the possibility of PE,and relevant examinations should be completed as soon as possible.