急性肺栓塞患者的长期预后因素分析

Analysis of long-term proggnnoosstitcic f afacctotorsrs i nin p paatiteienntsts w witihth a accuutete p puulmonary embolism

目的 分析不同病情急性肺栓塞(acute pulmonary embolism,APE)患者的临床资料、实验室检查,探讨APE患者发生不良事件的影响因素,以进行合理治疗改善预后。方法 选取2012年5月—2019年6月期间蚌埠医学院第一附属医院单中心入组国家“十二五”“十三五”注册登记研究的APE患者202例,其中191例患者完成至少6个月的随访,146例患者完成36个月随访,随访结局事件为全因死亡率。使用单因素及多因素回归分析研究临床资料及实验室指标对患者长期预后的影响。结果 191例患者在确诊后6个月时随访:存活164例,死亡27例。多因素Cox回归分析显示:基础病为恶性肿瘤或慢性心肺疾病对APE 6个月的预后(短期预后)有显著影响(均P<0.05)。有146例患者完成36个月的随访,存活111例,累计死亡35例。多因素Cox回归分析显示:合并恶性肿瘤、慢性心肺疾病、低血清白蛋白水平对患者36个月的预后有显著影响。APE长期预后的独立危险因素包括:合并恶性肿瘤、合并慢性心肺疾病、低血清白蛋白水平。结论 合并恶性肿瘤、合并慢性心肺疾病、低血清白蛋白水平是APE患者长期预后的独立危险因素。合并恶性肿瘤、慢性心肺疾病无论是长期预后还是短期预后均较差,低血清白蛋白水平是APE患者长期预后的不良因素。

Objective To analyze the clinical data and laboratory tests of patients with acute pulmonary embolism(APE)in different conditions,explore the influencing factors of adverse events in patients with APE,and carry out reasonable treatment to improve the prognosis.Methods A single center of the First Affiliated Hospital of Bengbu Medical College enrolled 202 patients with APE in the national"Twelfth Five-Year Plan"and"Thirteenth Five-Year Plan"registration studies from May 2012 to June 2019,of which 191 patients completed at least 6-month follow-up,and 146 patients completed 3-year follow-up.The follow-up outcome was all-cause mortality.Univariate and multivariate regression were used to analyze the impact of clinical data and laboratory indicators on the long-term prognosis of patients.Results A total of 191 patients were followed up at 6 months after diagnosis:164 cases survived and 27 died.Multivariate COX regression showed that underlying disease of malignancy or chronic cardiopulmonary disease had a significant effect on APE 6-months prognosis(short-term prognosis,P<0.05).Totally 146 patients completed the 36-month follow-up,111 survived and 35 died.Multivariate COX regression showed that the combination of malignant tumors,chronic cardiopulmonary diseases,and low serum albumin levels had a significant impact on the 36-month prognosis of patients.The independent risk factors for the long-term prognosis of APE included combination of malignant tumors,chronic cardiopulmonary diseases,and low serum albumin levels.Conclusion The combination of malignant tumors,chronic cardiopulmonary diseases,and low serum albumin levels are independent factors affecting the long-term prognosis of pulmonary embolism.Combination of malignant tumors and chronic cardiopulmonary diseases,both long-term and short-term prognosis are poor.Low serum albumin level is an adverse factor for long-term prognosis in acute pulmonary embolism.