Effects of aspirin on the expression of nuclear factor-κB in a rat model of acute pulmonary embolism

BACKGROUND:Acute pulmonary embolism(APE) is a disorder involving the pulmonary circulation resulting from a blockage of the pulmonary artery. The present study aimed to investigate the effects of aspirin on the nuclear factor-κB(NF-κB) activity in a rat model of APE.METHODS:A total of 108 healthy male Sprague-Dawley rats were randomly assigned into six groups(n=18 rats per group):control group,sham operation group,APE model group,and low-,medium- and high-dose aspirin groups. Six,24,and 72 hours after the induction of APE,rats in the low-,medium- and high-dose aspirin groups were given aspirin at a respective daily dose of 150,300,and 600 mg/kg by gavage for three consecutive days. Rats in the other groups were treated with equal volumes of normal saline. Six rats in each group were anesthetized with 10% chloral hydrate solution at each time point,and then the lung tissues were collected and analyzed using immunohistochemical staining.RESULTS:Positive immunohistochemical staining was present in the bronchial epithelial cells,alveolar cells,macrophages,and surrounding bronchial smooth muscle cells. When compared with the APE model group,the number of positive cells was signif icantly lower in the other groups at each time point(P<0.001). Statistically signif icant differences were also observed among the aspirin-treated groups at 6 hours(P<0.05,P<0.001). Compared with the APE model group,NF-κB protein expression was reduced in the other groups at each time point(P<0.05,P<0.001). Rats from the APE model group had thrombosis,damaged alveolar walls,and pulmonary hemorrhage,along with different degrees of inf lammatory cellular inf iltration at each time point. However,pathological changes such as pulmonary hemorrhage and inf iltration of inf lammatory cells were attenuated after the aspirin treatment.CONCLUSION:Aspirin can signifi cantly inhibit NF-κB activity in the lung of rats with APE in a dose-dependent manner,and can alleviate lung injury after APE.

Anesthetic management for intraoperative acute pulmonary embolism during inferior vena cava tumor thrombus surgery:A case report

BACKGROUND Acute pulmonary embolism(APE)is a rare and potentially life-threatening condition,even with early detection and prompt management.Intraoperative APE required specific ways for detecting since classic symptoms of APE in the awake patient could not be observed or self-reported by the patient under general anesthesia.CASE SUMMARY A 44-year-old man with a history of hepatic cell carcinoma was admitted for radical nephrectomy and tumor thrombectomy due to a newly found kidney tumor with inferior vena cava(IVC)tumor thrombus.APE that occurred during tumor thrombectomy with hypercapnia and desaturation.The capnography combined with the transesophageal echocardiography(TEE)provided a crucial differential diagnosis during the operation.The patient was continuously managed with aggressive intravenous fluid resuscitation and blood transfusion under continuous cardiac output monitoring to maintain hemodynamic stability.He completed the surgery under stable hemodynamics and was extubated after percutaneous mechanical thrombectomy by a certified cardiologist.There were no significant symptoms and signs or obvious discomfort in the patient’s self-report during visits to the general ward.CONCLUSION Under general anesthesia for IVC tumor thrombus surgery,a sudden decrease in end-tidal carbon dioxide is the initial indicator of APE,which occurs before hemodynamic changes.When intraoperative APE is suspected,TEE is useful in the diagnosis and monitoring before computer tomography pulmonary angiogram.Timely clinical impression and supportive treatment and intervention should be conducted to obtain a better prognosis.

Increasing angiotensin-converting enzyme(ACE)2/ACE axes ratio alleviates early pulmonary vascular remodeling in a porcine model of acute pulmonary embolism with cardiac arrest

BACKGROUND:Acute pulmonary embolism(APE)with cardiac arrest(CA)is characterized by high mortality in emergency due to pulmonary arterial hypertension(PAH).This study aims to determine whether early pulmonary artery remodeling occurs in PAH caused by massive APE with CA and the protective effects of increasing angiotensin-converting enzyme(ACE)2-angiotensin(Ang)(1-7)-Mas receptor axis and ACE-Ang II-Ang II type 1 receptor(AT1)axis(ACE2/ACE axes)ratio on pulmonary artery lesion after return of spontaneous circulation(ROSC).METHODS:To establish a porcine massive APE with CA model,autologous thrombus was injected into the external jugular vein until mean arterial pressure dropped below 30 mmHg(1 mmHg=0.133 kPa).Cardiopulmonary resuscitation and thrombolysis were delivered to regain spontaneous circulation.Pigs were divided into four groups of five pigs each:control group,APE-CA group,ROSC-saline group,and ROSC-captopril group,to examine the endothelial pathological changes and expression of ACE2/ACE axes in pulmonary artery with or without captopril.RESULTS:Histological analysis of samples from the APE-CA and ROSC-saline groups showed that pulmonary arterioles were almost completely occluded by accumulated endothelial cells.Western blotting analysis revealed a decrease in the pulmonary arterial ACE2/ACE axes ratio and increases in angiopoietin-2/angiopoietin-1 ratio and expression of vascular endothelial growth factor(VEGF)in the APE-CA group compared with the control group.Captopril significantly suppressed the activation of angiopoietin-2/angiopoietin-1 and VEGF in plexiform lesions formed by proliferative endothelial cells after ROSC.Captopril also alleviated endothelial cell apoptosis by increasing the B-cell lymphoma-2(Bcl-2)/Bcl-2-associated X(Bax)ratio and decreasing cleaved caspase-3 expression.CONCLUSION:Increasing the ACE2/ACE axes ratio may ameliorate pulmonary arterial remodeling by inhibiting the apoptosis and proliferation of endothelial cells after ROSC induced by APE.

A fast-track diagnostic and therapeutic strategy for acute pulmonary embolism patients at peri-operational period

Acute pulmonary embolism(APE) in operation room is a constant,lethal but treatable disease.A fast determination of APE in an operation room is currently difficult due to a non-specificity on its signs,symptoms,electrocardiograph findings,arterial blood gas abnormalities and chest X-rays.Clinically,an APE can automatically originate from a small and clinically asymptomatic embolus to massive,proximal emboli with shock during a scheduled surgery period.An accurate,brief and prompt diagnostic and therapeutic strategy for APE in a peri-operation period is crucial for anesthesiologists to make a decision on an appropriate clinical intervention to improve patients' outcomes.The purpose of this mini-review article is to illuminate a fast-track diagnostic and therapeutic strategy for APE patients in a perioperative period through a hybrid of the high sensitive and high specific viable diagnostic modality of D-dimer assay in conjunction with necessary emergent pulmonary angiography(EPA),including digital subtraction angiography(DSA),or a spiral computed tomography angiography(sCTA) for APE patients' diagnosis and treatment during operation.The postulated fast-track diagnostic and therapeutic strategy can effectively confirm or exclude highly suspected APE and simultaneously provide fast therapeutic opportunities for APE patients at an operative period.

Combined use of extracorporeal membrane oxygenation with interventional surgery for acute pancreatitis with pulmonary embolism: A case report

BACKGROUND Acute pancreatitis(AP) is an acute inflammatory process of the pancreas characterized by self-digestion of pancreatic tissue, which can trigger a systemic inflammatory response. Venous thrombosis, resulting from a hypercoagulable state, is a vascular complication of AP. AP complicated by pulmonary embolism(PE) is very rare, and the combined use of extracorporeal membrane oxygenation(ECMO) with a vascular interventional procedure for AP complicated by PE is even rarer.CASE SUMMARY A 32-year-old man with a history of obesity developed rapidly worsening AP secondary to hypertriglyceridemia. During treatment, the patient developed chest tightness, shortness of breath, and cardiac arrest. Computed tomography(CT) scans of his upper abdomen were consistent with pancreatitis. PE was identified by chest CT angiography involving the right main pulmonary artery and multiple lobar pulmonary arteries. The patient’s D-dime level was significantly elevated(> 20 mg/L). The patient received high-frequency oxygen inhalation, continuous renal replacement therapies, anti-infective therapy, inhibition of pancreatic secretion, emergent endotracheal intubation, and advanced cardiac life support with cardiopulmonary resuscitation. Following both ECMO and a vascular interventional procedure, the patient recovered and was discharged.CONCLUSION PE is a rare but potentially lethal complication of AP. The early diagnosis of PE is important because an accurate diagnosis and timely interventional procedures can reduce mortality. The combined use of ECMO with a vascular interventional procedure for AP complicated by PE can be considered a feasible treatment method. A collaborative effort between multiple teams is also vital.

Missed acute pulmonary embolism and sudden death: A case report

Rationale: Pulmonary embolism is a severe cardiovascular disease. Acute pulmonary embolism is an extremely common and potentially the serious pattern of venous thromboembolic disease. Unfortunately, missed diagnosis of pulmonary embolism is lethal and common because of its non-specific symptoms and signs. Patient concerns: A 42-year-old male patient presented with acute chest pain that was treated as gastroesophageal reflux disease. Diagnosis: Suspected acute pulmonary embolism. Interventions: O2inhalation, urgent electrocardiography, and cardiopulmonary resuscitation. Outcomes: Deterioration and sudden cardiac death. Lessons: Physicians should pay much attention to the symptoms and signs of pulmonary embolism to reduce the rate of missed diagnosis.

Acute pancreatitis with pulmonary embolism:A case report

BACKGROUND Acute pancreatitis(AP)is a common critical disease of the digestive system that is often associated with multiple complications.Vascular complications are relatively rare and are one of the causes of death.AP complicated with pulmonary embolism(PE)is even rarer,and there are no reports of AP complicated with PE in elderly patients.CASE SUMMARY We describe a rare case of AP complicated with PE and review the literature.A 68-year-old woman was diagnosed with AP due to widespread abdominal pain.During the course of treatment,the patient had shortness of breath and progressively worsening dyspnea without chest pain or hemoptysis with a progressive increase in D-dimer and fibrin degradation product.Respiratory failure and right heart failure occurred,and refractory hypoxemia remained after mechanical ventilation.Plain chest computed tomography revealed a small amount of left pleural effusion and external pressure atelectasis in the lower lobe of the left lung but no findings that could lead to refractory hypoxemia.Color Doppler ultrasound indicated pulmonary hypertension and extensive venous thrombosis in the lower extremities.Chest computed tomography angiography finally suggested pulmonary thromboembolism.The patient’s dyspnea symptoms disappeared after anticoagulation treatment.CONCLUSION During the diagnosis and treatment of AP,it is necessary to dynamically monitor D-dimer and consider PE.

Changes and Significance of Cytokines in Serum of Rabbits with Acute Pulmonary Embolism

Objective:To observe the changes of cytokines in serum of rabbits with acute pulmonary embolism,and to provide a scientific basis for clinical treatment of the disease.Methods:The animal models of pulmonary embolism were established in 26 healthy rabbits by autologous thrombus reinfusion and normal saline injection,and the serum levels of cytokines(TNF-α,IL-1β,HGF)in the two groups were monitored by enzyme-linked immunosorbent assay.Results:The expression levels of serum inflamma­tory cytokines(TNF-α,IL-1β)increased in both groups of rabbits within 1-3 hours of the acute stage of embolism,but the expression levels of serum inflammatory cytokines in experimental group of rabbits with pulmonary embolism caused by thrombosis increased more obviously.There was no significant change in serum HGF of rabbits before and after embolization in group B.The serum HGF content of experimental rabbits at 1 h,3 h,12 h,24 h and 48 h after embolization was significantly higher than that before embolization.And in the acute stage of embolism(1-12 hours),it showed a gradual upward trend.Conclusions:The expression level of serum growth factor is different in different acute stages of pulmonary embolism.Detect­ing serum cytokines in rabbits with acute pulmonary embolism is of great reference significance for improving clinical diagnosis.

THE PREDICTIVE VALUE OF ELECTROCARDIOGRAPHIC S_ⅠQ_ⅢT_Ⅲ PATTERN IN ACUTE PULMONARY EMBOLISM

Objective:To evaluate the predictive value of electrocardiographic SⅠQⅢTⅢ pattern in patients with acute pulmonary embolism . Method: ECG was analyzed retrospectively in 102 patients with acute pulmonary embolism confirmed by spiral CT scan and Compared the clinical data between SⅠQⅢTⅢ positive and negative group. Result: In 102 patients 29 cases have positive SⅠQⅢTⅢ , positive rate was 28.4%. In SⅠQⅢTⅢ positive group and SⅠQⅢTⅢ negative group, 41.4% vs 69.9% have vulnerable diagnosis before admitted, respectively(P < 0.05),as well as the massive PE 48.3% vs 23.3% (P < 0.05),mortality rate 24.1% vs 10.9(P < 0.05),bilateral PE 86.3% vs 65.8%(P < 0.05) and right side PE 10.3% vs 31.5%(P < 0.05).Conclusion : positive Electrocardiographic SⅠQⅢTⅢ could not be served as the basic diagnosis criteria for acute PE . positive SⅠQⅢTⅢ ECG could decrease the misdiagnosis of acute PE, indicate higher possibility of bilateral and massive acute PE.

Acute Colonic Pseudo-Obstruction (ACPO): An Expanding Colon with Unusual Risk Factors

The distention of the colon without mechanical or anatomical obstruction, Acute Colonic Pseudo-obstruction (ACPO), is a common condition occurring in the critically ill. ACPO in the setting of an acute pulmonary embolism and embolic stroke is a rarity. A 76-year-old female with shortness of breath, left hemiparesis and right-sided paresthesias presented with acute pulmonary embolism and acute infarcts of the left caudate nucleus, thalamus and occipital lobe. Her hospitalization was complicated with persistent distention of the large bowel without dilation of the small bowel. Empiric antibiotics were initiated without improvement and laboratory studies including Clostridium difficile were negative. She underwent nasogastric decompression and two decompressive colonoscopies with a resolution of her symptoms. This case illustrates an example of acute abdominal distension, without underlying etiology, in the setting of acute embolism of the pulmonary and cerebral vasculature. Early identification and action with decompressive colonoscopy were key to preventing further bowel damage or rupture.

A machine learning model for diagnosing acute pulmonary embolism and comparison with Wells score,revised Geneva score,and Years algorithm

Background:Acute pulmonary embolism(APE)is a fatal cardiovascular disease,yet missed diagnosis and misdiagnosis often occur due to non-specific symptoms and signs.A simple,objective technique will help clinicians make a quick and precise diagnosis.In population studies,machine learning(ML)plays a critical role in characterizing cardiovascular risks,predicting outcomes,and identifying biomarkers.This work sought to develop an ML model for helping APE diagnosis and compare it against current clinical probability assessment models.Methods:This is a single-center retrospective study.Patients with suspected APE were continuously enrolled and randomly divided into two groups including training and testing sets.A total of 8 ML models,including random forest(RF),Naïve Bayes,decision tree,K-nearest neighbors,logistic regression,multi-layer perceptron,support vector machine,and gradient boosting decision tree were developed based on the training set to diagnose APE.Thereafter,the model with the best diagnostic performance was selected and evaluated against the current clinical assessment strategies,including the Wells score,revised Geneva score,and Years algorithm.Eventually,the ML model was internally validated to assess the diagnostic performance using receiver operating characteristic(ROC)analysis.Results:The ML models were constructed using eight clinical features,including D-dimer,cardiac troponin T(cTNT),arterial oxygen saturation,heart rate,chest pain,lower limb pain,hemoptysis,and chronic heart failure.Among eight ML models,the RF model achieved the best performance with the highest area under the curve(AUC)(AUC=0.774).Compared to the current clinical assessment strategies,the RF model outperformed the Wells score(P=0.030)and was not inferior to any other clinical probability assessment strategy.The AUC of the RF model for diagnosing APE onset in internal validation set was 0.726.Conclusions:Based on RF algorithm,a novel prediction model was finally constructed for APE diagnosis.When compared to the current clinical assessment strategies,the RF model achieved better diagnostic efficacy and accuracy.Therefore,the ML algorithm can be a useful tool in assisting with the diagnosis of APE.

Acute pulmonary embolism immediately after cesarean section despite dilatation of the left ventricle:a case report and literature review

Introduction Pulmonary embolism is a lethal complication during pregnancy and the puerperium.Compared with vaginal delivery,the risk of pulmonary disease is almost twice as high with cesarean section.However,diagnosing a pulmonary embolism can be challenging.Case presentation A 31-year-old nulliparous woman underwent cesarean section.Postoperatively,the patient suddenly developed dyspnea and dull pain in the left back region and cardiopulmonary function deteriorated rapidly.Venous ultrasonography confirmed thrombosis of the left common iliac vein.Transthoracic echocardiography revealed a normal right heart and a dilated left ventricle with a patent foramen ovale.An acute pulmonary embolism was confirmed by pulmonary angiography.Catheter-directed thrombus fragmentation and thrombolysis were then performed.Conclusion Dilated left ventricular echocardiography does not exclude postpartum acute pulmonary embolism.In extreme emergencies,when acute pulmonary embolism is the most likely diagnosis and life-threatening,catheter-directed angiography may be preferred over other approaches.

Pulmonary complications of transcatheter arterial chemoembolization for hepatocellular carcinoma

Transcatheter arterial chemoembolization(TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma(HCC). Post-TACE pulmonary complications resulting in acute lung injury(ALI) or acute respiratory distress syndrome(ARDS) are rare events. Pulmonary complications after TACE are thought to be related to chemical injury subsequent to the migration of the infused ethiodized oil or chemotherapeutic agent to the lung vasculature, facilitated by arteriovenous(AV) shunts within the hyper-vascular HCC. We review herein the literature on pulmonary complications related to TACE for HCC. Post-TACE pulmonary complications have included pulmonary oil embolism, interstitial pneumonitis, chemical pneumonitis, ALI, ARDS, lipoid pneumonia, acute eosinophilic and neutrophilic pneumonia, bilious pleuritis, pulmonary abscess, pulmonary tumor embolism, and possibly pulmonary metastasis with HCC. The risk factors associated with post-TACE pulmonary complications identified in the literature include large hyper-vascular HCC with AV shunts, large-volume Lipiodol infusion, and embolization via the right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. An astute awareness of the potential post-TACE pulmonary complications should expedite appropriate therapeutic interventions and increase potential for early recovery.

Acute myocardial injury in patients with COVID-19:Possible mechanisms and clinical implications

Severe acute respiratory syndrome coronavirus 2 infection affects not only the lungs,but also the cardiovascular system,having a major impact on patients’outcomes.Myocardial injury(MI)occurs in the context of coronavirus infectious disease 2019(COVID-19)and is associated with a higher risk of severe clinical outcome and mortality.COVID-19-related MI can have various clinical manifestations,of which the main ones are myocarditis,stress cardiomyopathy,acute coronary syndrome,and pulmonary embolism.The exact mechanisms of how MI occurs in these patients are not yet fully known.Direct injury,through direct viral myocardial invasion,and indirect injury,through interaction with angiotensin I converting enzyme 2,increased inflammation,and thrombocyte and endothelial dysfunction,could be involved in acute MI in patients with COVID-19.A better understanding of these multiple potential mechanisms may help to develop new targeted therapeutic strategies.The purpose of this review is to provide the current understanding of the potential mechanisms involved in MI induced by COVID-19 and to discuss the current progress in the therapeutic strategies.

利伐沙班联合阿替普酶治疗急性肺栓塞对患者凝血功能及GRP78 GRP94表达的影响

目的:观察利伐沙班联合阿替普酶对急性肺栓塞患者凝血功能及葡萄糖调节蛋白78(GRP78)、葡萄糖调节蛋白94(GRP94)表达的影响。方法:选取2021年1月至2022年12月我院收治的104例急性肺栓塞患者为对象,采用简单随机法分为两组。所有患者均给予绝对卧床、止痛、抗感染、吸氧等常规治疗,常规组(n=52)加用阿替普酶治疗,联合组(n=52)加用利伐沙班联合阿替普酶治疗。统计两组出血事件发生率。检测两组凝血功能、血栓弹力图及GRP78、GRP94、肺动脉压、血气指标的差异。结果:两组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)及血栓弹力图中α角、反应时间(R)治疗后较治疗前升高,联合组治疗前后APTT、PT及血栓弹力图中R、α角差值大于常规组(P<0.05)。两组纤维蛋白原(Fib)、D-二聚体(D-D)治疗后较治疗前降低,联合组治疗前后Fib、D-D差值大于常规组(P<0.05);两组血栓弹力图中凝血时间(K)治疗前后比较,差异无统计学意义(P>0.05)。两组GRP78、GRP94治疗后较治疗前降低,联合组治疗前后GRP78、GRP94差值大于常规组(P<0.05)。两组动脉血氧分压(PaO 2)治疗后较治疗前升高,联合组治疗前后PaO 2差值大于常规组(P<0.05);两组动脉血二氧化碳分压(PaCO 2)治疗后较治疗前降低,联合组治疗前后PaCO 2差值大于常规组(P<0.05)。两组出血事件发生率比较,差异无统计学意义(P>0.05)。结论:利伐沙班联合阿替普酶治疗急性肺栓塞可降低GRP78、GRP94的表达,改善凝血功能和血气指标。

CT心功能参数结合生化指标及Wells评分在急性肺动脉栓塞30 d不良预后中的评估价值

目的 探讨256层螺旋CT心功能相关参数、实验室指标及Wells评分对急性肺栓塞(acute pulmonary embolism, APE)严重程度的诊断效能,观察联合应用对提高急性肺栓塞患者30 d不良预后的预测价值。方法 纳入2018年5月至2021年11月行肺CT血管造影(CTPA)检查确诊为急性肺动脉栓塞住院患者进行回顾性分析,随访30 d且资料齐全者共225例,对照组为同期接受CTPA检查并确诊无肺栓塞患者70例。收集患者临床资料和实验室指标[肌酸激酶(CK)、肌酸激酶-特异性同工酶(CK-MB)和D-二聚体],计算Wells评分。采用心功能软件定量测量右心室(RV)、左心室(LV)体积;分别在横轴位图像、重建四腔心层面上测量右、左心室短径及截面积,计算其比值。对2组患者的上述定量指标进行分析。结果 2组患者肺部感染、冠心病史、既往肺栓塞或深静脉血栓病史、癌症活动期、手术/制动史及心率≥100次/min比较差异有统计学意义(P<0.05)。RVD/LVD-ax、RVA/LVA-ax、RVD/LVD-4ch、RVA/LVA-4ch、RVV/LVV、D-二聚体及Wells评分在对照组、急性肺栓塞预后良好与预后不良间差异有统计学意义(P<0.05)。RVD/LVD-ax在预测30 d不良预后及早期死亡方面AUC值最大,分别为0.692、0.724。RVA/LVA-ax与D-二聚体、Wells评分三者联合检测时在预测早期死亡方面AUC值最大。ROC曲线分析显示冠状窦直径>8.65 mm时急性肺栓塞后右心后负荷增加的风险增大。结论 RVA/LVA-ax与D-二聚体、Wells评分三者联合预测效能最佳;与重建四腔心径线、面积及体积相比,横轴位测量心脏形态改变对评价APE预后更优;当冠状窦直径>8.65 mm时急性肺栓塞后右心后负荷增加的风险增大,可帮助临床进行风险分层。

急性非高危肺栓塞患者的临床、影像及风险分层特征分析

目的 对比急性非高危肺栓塞患者不同栓塞类型的临床、影像及风险分层特征分析。方法 收集在本院通过CTPA确诊的非高危急性肺栓塞患者进行回顾性分析,对比不同类型急性肺栓塞患者临床以及影像学特征,并探索肺栓塞类型与早期风险分层之间的关系。结果 277例非高危急性肺栓塞患者中,鞍型MPA栓塞34例,约占12.27%,不同类型栓塞患者在性别、年龄、有无下肢静脉血栓及合并症上比较差异无统计学意义(P>0.05);而在影像学特征(PAOI、肺动脉直径、肺/主动脉比值、RV/LV比值)中发现,鞍状肺栓塞与非鞍状肺栓塞、非MPA栓塞中存在显著差异,(P<0.05);不同类型的急性非高危肺栓塞患者危险分层,在sPESI评分中,非鞍型MPA栓塞和非MFA栓塞患者多被划分为中-低危组,而在Bova评分中,Boval级患者的比例较高。结论不同类型急性非高危肺栓塞患者严重程度存在差异,鞍状肺栓塞和非鞍状肺栓塞患者较非MPA患者的肺动脉高压及右心室功能障碍出现的频率更高,肺栓塞影像学指标再结合患者临床及实验室检查,有助于早期识别患者危险度,为患者的治疗及预后提供更大帮助。

Pulmonary Embolism in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective： In most cotintries, nearly 6% of the adults are suffering from chronic obstructive pulmonary disease （COPD）. which puts a huge economic burden on the society. Moreover, COPD has been considered as an independent risk factor for pulmonary embolism （PE）. In this review, we summarized the existing evidence that demonstrates the associations between COPD exacerbation and PE from various aspects, including epidemiology, pathophysiological changes, risk factors, clinical features, management, and prognosis. Data Sources： We searched the terms ＂chronic obstructive pulmonary disease,＂ ＂＇pulmonary embolism,＂ ＂exacerbations,＂ and ＂＇thromboembolic＂ in PubMed database and collected the results up to April 2018. The language was limited to English. Study Selection： We thoroughly examined the titles and abstracts of all studies that met our search strategy. The data from prospective studies, meta-analyses, retrospective studies, and recent reviews were selected for preparing this review. Results： The prevalence of PE in patients with COPD exacerbation varied a lot among different studies, mainly due to the variations in race, sample size, study design, research setting, and enrollment criteria. Overall, whites and African Americans showed significantly higher prevalence of PE than Asian people, and the hospitalized patients showed higher prevalence of PE compared to those who were evaluated in emergency department. PE is easily overlooked in patients with COPD exacerbation due to the similar clinical symptoms. However, several factors have been identified to contribute to the increased risk of PE during COPD exacerbation. Obesity and lower limb asymmetry were described as independent predictors for PE. Moreover, due to the high risk of PE, thromboprophylaxis has been used as an important treatment for hospitalized patients with COPD exacerbation. Conclusions： According to the previous studies, COPD patients with PE experienced an increased risk of death and prolonged length of hospital stay. Therefore, the thromboembolic risk in patients with acute exacerbation of COPD, especially in the hospitalized patients, should carefully be evaluated.

新型炎症指标对急性肺栓塞诊断及预后价值研究进展

急性肺栓塞(APE)是常见的急危重心血管疾病之一。目前,用于诊断APE的方法主要依赖影像学检查和实验室检查。常用的影像学检测方法复杂,且还有耗时长、急重症患者搬运不便、检查费用高昂等缺点,因此,探寻一种简单、经济、有效的评估方法,对急性非高危肺栓塞患者诊断及预后具有重要临床意义。免疫/炎症反应是血管疾病发病机制中的一个重要环节,血液中具有代表性的指标包括中性粒细胞/淋巴细胞比值、单核细胞相关指标、血小板/淋巴细胞比值、全身免疫炎症指数等新型炎症指标。该文重点阐述了新型炎症指标对APE患者的诊断及预后的预测价值。