泰安地区急性肺栓塞患者临床特征及相关危险因素分析

Clinical characteristics and related risk factors analysis of acute pulmonary embolism patients in Tai'an area

目的分析泰安地区急性肺栓塞(APE)住院患者的流行病学特点和临床特征,探讨APE患者住院死亡的相关危险因素。方法收集自2016年10月1日至2021年10月1日期间于泰安市中心医院收治的APE患者,根据肺栓塞简化危险分层评估表(sPESI)进行分组,回顾性比较高危组与非高危组患者的流行病学特点、临床特征、治疗及预后情况。将APE研究组与对照组(同期健康查体者)比较,分析白细胞计数、D-二聚体、超敏C反应蛋白(hs-CRP)、载脂蛋白A1(apoA1)等生化指标以及超声心动图等数据进行统计学及多元logistic回归分析,研究其与APE发病及预后的相关性。结果本研究纳入467例APE患者,其中男性212例,女性255例。近年来APE发病率逐年增加,以冬季发病为主。初诊患者主要症状为呼吸困难及气促(憋喘),其次为咳嗽、心悸、胸痛、晕厥和咯血等。泰安市APE患者危险因素占比最高的为下肢静脉血栓及静脉曲张。计算机体层成像肺血管造影(CTPA)结合静态超声心动图(UCG)可提高疾病的临床诊断率。高危组肺动脉高压比例及右室增大比例高于非高危组。所有确诊患者治疗初期均接受抗凝治疗(除外无法抗凝者),好转392例,死亡11例,自动出院29例。吸烟、年龄、低血压或休克、呼吸困难、胸腔积液、肺部感染、sPESI为APE死亡的独立危险因素。结论尽早抗凝是APE患者的有效治疗方案,进一步延长患者生存期,降低死亡率。

Objective To analyze the epidemiological and clinical characteristics of hospitalized patients with APE in Tai'an area,and to explore the risk factors and peripheral blood biochemical characteristics of hospitalized patients with APE.Methods APE patients admitted to Tai'an Central Hospital from October 1,2016 to October 1,2021 were collected and grouped according to simplified risk Stratification Assessment Form(sPESI)for pulmonary embolism.Retrospective comparison of epidemiological characteristics,clinical manifestations,treatment,and prognostic outcomes between high-risk and non high-risk groups of patients.The APE study group was compared with the control group(healthy patients hospitalized during the same period),and the biochemical indexes such as white blood cell count,D-dimer,hypersensitive CRP apolipoprotein A1(apoA1)and echocardiogram data were analyzed for statistical and multiple logistic regression analysis to study the correlation between APE and the incidence and prognosis.Results Among 467 APE patients in this study,212 were males and 255 were females;In the past five years,the incidence rate has increased year by year,with the most significant incidence rate in winter.The main symptoms were dyspnea and shortness of breath,followed by cough,palpitation,chest pain,syncope and hemoptysis.The highest risk factors of APE patients in Tai'an city were lower limb venous thrombosis and varicose veins,followed by hypertension.Computed tomography pulmonary angiography(CTPA)combined with static echocardiography(UCG)can improve the clinical diagnostic rate of diseases.The proportion of pulmonary hypertension and right ventricular enlargement in the high-risk group was higher than that in the non high-risk group.All confirmed patients received anticoagulation treatment at the beginning of treatment(excluding those who were unable to anticoagulate),with 392 cases improving,11 deaths,and 29 cases automatically discharged.Smoking,age,hypotension or shock,difficulty breathing,pleural effusion,pulmonary infection,and sPESI are independent risk factors for APE death.Conclusion Early anticoagulation is the effective treatment of APE.