慢性阻塞性肺疾病急性加重合并下肢深静脉血栓中医证素及危险因素分析

Analysis of TCM Syndrome Elements and Related Risk Factors of Acute Exacerbation ofChronic Obstructive Pulmonary Disease with Deep Venous Thrombosis of Lower Limbs

目的分析慢性阻塞性肺疾病急性加重(AECOPD)住院患者合并下肢深静脉血栓(DVT)的中医证素特点及相关危险因素。方法回顾性纳入AECOPD住院患者340例,根据下肢静脉超声结果判断是否合并DVT,分为DVT组32例和非DVT组308例,并经倾向性评分得到30对匹配病例,比较两组患者一般情况、相关检验检查结果、中医证素及四诊信息的差异。相关危险因素应用二元Logistic回归分析,并对四诊信息与证素,血气、炎症指标与D-二聚体进行相关性分析。结果该研究共纳入AECOPD住院患者340例,发生DVT者32例(占9.41%),与非DVT组比较,DVT组卧床时间≥3 d及AECOPD严重程度属Ⅱ、Ⅲ级的患者明显增多,动脉血氧分压(PaO_(2))水平降低更显著,动脉血二氧化碳分压(PaCO_(2))、中性粒细胞百分比(NEUT%)、D-二聚体水平升高更显著,出现乏力、面色晦暗、唇甲发绀、舌下络脉色黯/迂曲、舌质黯红表现的患者明显增多(P<0.05,P<0.01)。非DVT组病位单纯在肺者更多,DVT组病位及心,病性要素属“血瘀”“气虚”者更多(P<0.05,P<0.01),DVT组以痰热血瘀兼气虚占比最高(36.67%),明显高于非DVT组(6.67%)。二元Logistic回归结果显示:卧床时间≥3 d(OR=45.535,P=0.002)、D-二聚体升高(OR=13.095,P=0.037)、痰热血瘀兼气虚(OR=8.832,P=0.048)是AECOPD住院患者合并DVT的独立危险因素。进一步分析发现乏力、面色晦暗、舌下脉络色黯/迂曲、舌质黯红与痰热血瘀兼气虚存在正向相关性(0<r<1,P<0.05),NEUT%、PaCO_(2)与D-二聚体存在正向相关性(0<r<1,P<0.05);PaO_(2)与D-二聚体存在负向相关性(-1<r<0,P<0.05)。结论AECOPD合并DVT的发生率较高,对存在卧床时间长、D-二聚体升高、痰热血瘀兼气虚等相关危险因素的患者应提高警惕并及早进行预防性抗凝治疗。

Objective To analyze the characteristics of TCM syndromic elements and related risk factors in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with lower extremity deep vein thrombosis(DVT).Methods Retrospective inclusion of 340 hospitalized AECOPD patients,based on lower limb venous ultrasound results to determine whether DVT is present,was divided into DVT group(n=32)and non DVT group(n=308),and 30 matched cases were obtained through propensity score.To compare the differences in general situation,relevant test results,TCM syndrome elements,and four diagnostic information between the two groups of patients;The relevant risk factors were analyzed using binary logistic regression analysis;The correlation between the four diagnostic information and syndrome elements,blood gas,inflammatory factors and D-dimer was analyzed.Results A total of 340 AECOPD inpatients were included in this study,and 32 patients(9.41%)had DVT.Compared with the non DVT group,the number of patients in the DVT group with bed rest time≥3 days and AECOPD severity gradeⅡandⅢwere significantly increased.the level of arterial partial oxygen pressure(PaO_(2))decreased more significantly,the level of arterial partial carbon dioxide pressure(PaCO_(2)),the percentage of neutrophils(NEUT%),the level of D-dimer increased more significantly,and the number of patients with fatigue,dark complexion,cyanosis of labial nails,dark/tortuous sublingual veins,anddark redincreased significantly(P<0.05,P<0.01).The non DVT group had more cases of disease located solely in the lungs,while the DVT group had more cases of disease related factors such as“blood stasis”and“Qi deficiency”(P<0.05,P<0.01).The DVT group had the highest proportion of syndrome elements with phlegm heat and blood stasis combined with Qi deficiency(36.67%),which was significantly higher than the non DVT group(6.67%).The results of binary logistic regression showed that the time spent in bed≥3 days(OR=45.535,P=0.002),the increase of D-dimer(OR=13.095,P=0.037),phlegm heat,blood stasis and Qi deficiency(OR=8.832,P=0.048)were independent risk factors for AECOPD inpatients with DVT.Further analysis showed that the fatigue,dark complexion,dark/tortuous sublingual vein,anddark red tongue substance were positively correlated with phlegm heat and blood stasis combined with Qi deficiency(0<r<1,P<0.05),NEUT%and PaCO_(2) were positively correlated with D-dimer(0<r<1,P<0.05);There was negative correlations between PaO_(2) and D-dimer(-1<r<0,P<0.05).Conclusion The incidence of AECOPD combined with DVT is relatively high.Patients with long bed rest time,elevated D dimer,phlegm blood stasis and Qi deficiency and other related risk factors should be vigilant and receive preventive anticoagulation therapy as soon as possible.