急性肺栓塞患者抗栓治疗后残余肺血管阻塞危险因素分析

Risk factors of residual pulmonary vascular obstruction in patients with acute pulmonary embolism after antithrombotic therapy

目的:探讨急性肺栓塞(APE)患者经至少3个月抗栓治疗后,残余肺血管阻塞(RPVO)的危险因素。方法:回顾性分析2020年1月—2022年7月在天津医科大学总医院治疗的95例APE患者的一般资料、首发症状、危险分层、简化版肺栓塞严重指数(sPESI)、辅助检查结果。依据复查肺动脉造影(CTPA)有无RPVO将受试者分为残余血栓组36例和非残余血栓组59例,行单因素和多因素Logistic回归分析探究RPVO形成的独立危险预测因素。结果:单因素分析显示,两组性别、年龄、吸烟史、基础疾病、症状、危险分层、s PESI差异无统计学意义(均P>0.05);残余血栓组特发性肺栓塞、症状与诊断间隔时间≥7 d、右心室扩张、中央型血栓、乳酸和纤维蛋白原水平均高于非残余血栓组(χ^(2)=4.477、3.986、4.978、3.997、3.004、2.559,均P<0.05)。Logistic回归分析发现,症状与诊断间隔时间越长(OR=4.007,95%CI:1.271~12.636,P=0.018)、乳酸(OR=3.695,95%CI:1.257~10.860,P=0.017)及纤维蛋白原水平(OR=2.005,95%CI:1.061~3.790,P=0.032)越高,RPVO形成的风险越高,三者为RPVO形成的独立危险预测因素。结论:症状与诊断间隔时间≥7 d、乳酸及纤维蛋白原水平对RPVO的发生具有促进作用。

Objective:To investigate the risk factors of residual pulmonary vascular obstruction(RPVO)in patients with acute pulmonary embolism(APE)after at least 3 months of antithrombotic therapy.Methods:The general data,first symptom,risk stratification,sPESI and auxiliary tests of 95 patients with APE treated at General Hospital Tianjin Medical University from January 2020 to July 2022 were retrospectively analyzed.The subjects were divided into 36 cases in the residual thrombosis group and 59 cases in the non-residual thrombosis group according to the presence or absence of RPVO during pulmonary angiography(CTPA)re-examination,and univariate and multivariate Logistic regression analysis was performed to explore independent risk predictors of RPVO formation.Results:Univariate analysis showed that there were no significant differences in gender,age,smoking history,underlying diseases,symptoms,risk stratification and simplified version of pulmonary embolism severity index(sPESI)between the two groups(all P>0.05).The levels of idiopathic pulmonary embolism,interval between symptoms and diagnosis≥7 days,right ventricular dilation,central thrombus,lactic acid(Lac)and fibrinogen(FIB)in residual thrombus group were higher than those in non-residual thrombus group(χ^(2)=4.477,3.986,4.978,3.997,3.004,2.559,all P<0.05).Logistic regression analysis showed that the longer the interval between symptoms and diagnosis(OR=4.007,95%CI:1.271-12.636,P=0.018),the higher the Lac(OR=3.695,95%CI:1.257-10.860,P=0.017)and FIB(OR=2.005,95%CI:1.061-3.790,P=0.032),the higher the risk of RPVO formation,and the three were independent risk predictors of RPVO formation.Conclusion:The interval between symptoms and diagnosis is≥7 days,and the level of Lac and FIB can promote the occurrence of RPVO.