慢性阻塞性肺病急性加重伴肺栓塞的危险因素

摘要

目的 探讨慢性阻塞性肺病(chronic obstructive pulmonary disease,慢阻肺)急性加重伴发肺动脉栓塞(Pulmonary embolism,PE)的危险因素,提高慢阻肺患者伴发PE的诊断率,降低病死率.方法 回顾性分析我院2012年1月至2015年12月行多层螺旋CT肺动脉造影(CTPA)检查并临床诊断为AECOPD的117例病例,其中58例伴发PE,比较单纯慢阻肺急性加重组及伴发PE组的临床资料,采用多元回归分析寻找慢阻肺急性加重伴发PE的危险因素.结果 单纯慢阻肺组和伴发PE组下述临床指标存在显著差异:血D-二聚体水平、动脉血氧分压、下肢水肿、下肢静脉栓塞、CTPA上主肺动脉直径、主肺动脉与升主动脉直径比值、主肺动脉与降主动脉直径比值.多元回归分析显示:血D-二聚体(OR值为1.287,95%CI:1.008-1.643,P<0.05)、主肺动脉与升主动脉直径比值(OR值为2.924E3,95%CI:2.212-3.866E6,P<0.05)、肺动脉直径(OR值为1.821,95%CI:1.675-1.999,P<0.05) 为AECOPD伴发PE的危险因素.进一步行ROC曲线分析显示当血D-二聚体诊断临界值为1.245ug/mL时,AECOPD合并PE诊断特异度为72.9%,灵敏度为60.3%.主肺动脉与升主动脉直径比值为0.903时,AECOPD合并PE诊断特异度为72.9%,灵敏度为69%.肺动脉直径达33.845mm时,其诊断的特异度为69.5%,灵敏度为60.3%.结论 因急性加重而住院的慢阻肺患者,当D-二聚体>1.245ug/mL、主肺动脉与升主动脉直径比值>0.903或肺动脉直径>33.845mm时,应进一步行多层螺旋CT肺动脉造影(CTPA)检查,以便明确是否伴有PE,以减少漏诊、误诊,降低病死率.%Objective To study the risk factors of AECOPD patients complicated with pulmonary embolism, in order to improve the diagnostic rate of PE in patients with COPD.Methods 117 AECOPD patients from January 2012 to December 2015 who were examined by CT pulmonary angiography were selected in this study, including 58 cases of PE.Their clinical data were retrospectively analyzed, and multivariate regression analysis was used to find the risk factors of PE in AECOPD.Results Single factor analysis showed that the following factors were significantly different between the PE positive group and the PE negative group:?D-dimmer, PO2, edema of lower extremity, DVT, diameter of pulmonary artery, the ratio of pulmonary artery to ascending aorta diameter and the ratio of pulmonary artery to descending aorta diameter.Multiple regression analysis showed that D-dimmer (OR=1.287, 95%CI: 1.008-1.643, P<0.05), the ratio of pulmonary artery to ascending aorta diameter (OR=2.924E3, 95%CI: 2.212-3.866E6, P<0.05) and diameter of pulmonary artery (OR=1.821, 95%CI: 1.675-1.999, P<0.05) were the risk factors.When the cut-off point of D-dimmer was 1.245ug/mL, the sensitivity and specificity of COPD with PE were 60.3% and 72.9%.When the cut-off point of the ratio of pulmonary artery to ascending aorta diameter was 0.903, the sensitivity and specificity of COPD with PE were 69% and 72.9%.When the cut-off point of diameter of pulmonary artery was 33.845 millimeter, the sensitivity and specificity of COPD with PE were 60.3%and 69.5%.Conclusion Patients with AECOPD admitted to hospital should be considered for the presence of PE if they have the risk factors of D-dimmer>1.245ug/mL, the ratio of pulmonary artery to ascending aorta diameter>0.903 or the diameter of pulmonary artery>33.845 millimeter.