慢性阻塞性肺疾病急性加重合并肺栓塞血液相关风险因素分析

摘要

目的 分析慢性阻塞性肺疾病(COPD)急性加重(AECOPD)合并急性肺栓塞血液相关风险因素及其相关性分析,为发病机制研究、治疗提供参考.方法 纳入2015年5月至2016年4月入院的AECOPD可疑肺栓塞患者73例,检测其血常规、C反应蛋白(CRP)、白细胞介素-8(IL-8)、红细胞沉降率(ESR)、降钙素原(PCT)、内皮素-1(ET-1)、D-二聚体、纤维蛋白原、心肌酶、动脉血气、乳酸脱氢酶(LDH)等指标,并进行胸部肺动脉造影(CTPA)检查,分析AECOPD合并肺栓塞患者与未合并肺栓塞患者血液相关风险因素的关系.结果 73例患者中,有15例为AECOPD合并肺栓塞,58例为AECOPD未合并肺栓塞.AECOPD合并肺栓塞患者的Neu%、PCT、NT-proBNP、D-二聚体、LDH、cTnI、CRP、IL-8、ET-1水平整体高于未合并肺栓塞患者(P<0.05).AECOPD合并肺栓塞患者血CRP与IL-8相关系数为0.457(P=0.087),与ET-1相关系数为0.598(P=0.019),IL-8与ET-1相关系数为0.695(P=0.004).结论 AECOPD合并肺栓塞与体内炎症严重程度相关,炎性反应越重,对心肌损伤也相应增加,发生肺栓塞的风险增加.%Objective To analyze the risk factors of chronic obstructive pulmonary disease (COPD) in acute exacerbation (AE-COPD)complicated with pulmonary embolism ,and to provide reference for the pathogenesis and treatment .Methods A total of 73 patients with COPD suspected PE admitted to our hospital from May 2015 to April 2016 were enrolled in this study .All patients were examined including WBC ,Neu% ,CRP ,IL-8 ,ESR ,PCT ,ET-1 ,D-dimer ,fibrinogen ,NT-proBNP ,myocardial enzyme ,arterial blood gas ,lactic acid ,CT pulmonary angiography(CTPA)within 48 h of admission .The risk factors of AECOPD with PE or with-out PE were analyzed .Results There were 15 cases with PE ,58 cases without PE in all objects .Neu% ,PCT ,NT-proBNP ,D-di-mer ,LDH ,cTnI ,CRP ,IL-8 ,ET-1 in patients with PE were significant higher than those in patients without PE (P<0 .05) .In the PE group ,the correlation coefficient between CRP and IL-8 was 0 .457(P=0 .087) ,the correlation coefficient between CRP and ET-1 was 0 .598(P=0 .019) ,the correlation coefficient between IL-8 and ET-1 was 0 .695(P=0 .004) .Conclusion Acute exacer-bation of COPD combined with PE is associated with the severity of inflammation in the body ,the more serious the inflammatory re-action ,the corresponding increase in myocardial injury ,the higher the risk of PE .