摘要
目的探讨下肢深静脉血栓患者发生肺栓塞的危险因素。方法采用病例-对照研究的方法,收集华中科技大学同济医学院附属协和医院2013年1月到2014年12月确诊的下肢深静脉血栓患者共421例,根据肺动脉计算机断层摄影血管造影术（CTPA）的结果,将合并肺栓塞的患者纳入病例组,不合并肺栓塞的患者纳入对照组,并筛选各危险因素,用多因素Logistic回归分析其与肺栓塞的相关性。结果 421例下肢深静脉血栓患者中,219例发生肺栓塞,通过多因素Logistic回归分析显示：合并存在心脑血管疾病（OR=1.795,95%CI1.146~2.811,P=0.011）、慢性炎症性疾病（OR=2.333,95%CI1.386~3.927,P=0.001）与下肢深静脉血栓患者发生肺栓塞密切相关。其中心脑血管疾病包括脑梗死、高血压、冠心病、房颤、心脏瓣膜病、心源性肺动脉高压、扩张型心肌病。Logistic回归分析显示冠心病（OR=2.792,95%CI1.177~6.623,P=0.020）、心源性肺动脉高压（OR=11.472,95%CI 1.402~93.899,P=0.023）、心脏瓣膜病（OR=12.625,95%CI1.560~102.177,P=0.017）、扩张型心肌病（OR=2.626,95%CI 1.028~6.711,P=0.044）是下肢深静脉血栓患者发生肺栓塞的危险因素。慢性炎症性疾病包括呼吸系统慢性炎症性疾病、消化系统慢性炎症性疾病、慢性肾炎、结缔组织病,单因素分析显示呼吸系统慢性炎症性疾病（P〈0.01）是下肢深静脉血栓患者发生肺栓塞的危险因素,其中慢性支气管炎（OR=10.152,95%CI2.379~46.456,P=0.002）、慢性肺炎（OR=5.902,95%CI 1.254~27.787,P=0.025）的作用尤为显著。结论下肢深静脉血栓形成的患者合并心脑血管疾病和慢性炎症性疾病,尤其是合并冠心病、心脏瓣膜病、心源性肺动脉高压以及慢性肺炎和慢性支气管炎,发生肺栓塞的危险性增加。
Objective To analyze the risk factors of pulmonary embolism（PE）in patients with deep venous thrombosis （DVT）. Methods A total of 421 patients with DVT who were admitted and treated in Wuhan Union Hospital from January 2013 to December 2014 were enrolled in this case-control study.Patients were divided into case group（positive results of PE on CTPA）and control group（negative results of PE on CTPA）.Data including sex,smoking,drinking,surgery,immobilization, cancer,parturition,diabetes,hyperlipemia,hyperuricemia,cardiovascular and cerebrovascular diseases,chronic inflammatory dis-eases,were compared between patients with and without PE.The risk factors of PE in patients with DVT were assessed using multivariate logistic regression.Results In the 421 DVT patients,219（52%）developed PE.The multivariate logistic regression showed that concomitant cardiovascular and cerebrovascular diseases（OR=1.795,95%CI 1.146-2.811,P=0.011）and chro-nic inflammatory diseases（OR=2.333,95%CI 1.386-3.927,P=0.001）were significantly associated with the development of PE in DVT patients.Further statistical results indicated that coronary heart disease（OR=2.792,95%CI 1.177-6.623,P=0.020）,cardiac pulmonary hypertension（OR=11.472,95%CI 1.402-93.899,P=0.023）,heart valve disease（OR=12.625, 95%CI 1.560-102.177,P=0.017）,dilated cardiomyopathy（OR=2.626,95%CI 1.028-6.711,P=0.044）,chronic pneu-monia（OR=5.902,95%CI 1.254-27.787,P=0.025）,and chronic bronchitis（OR=10.152,95%CI 2.379-46.456,P=0.002）were risk factors for PE.Conclusion Coronary heart disease,cardiac pulmonary hypertension,heart valve disease,dilated cardiomyopathy,chronic pneumonia and chronic bronchitis are risk factors of PE in DVT patients.
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2016年第3期319-323,共5页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
基金
国家自然科学基金资助项目(No.81370425)
作者简介
冯玉倩，女，1991年生，硕士研究生，E-mail：398294950@qq．com；
张少韶，男，1987年生，硕士研究生，E-mail：395920216@qq．com
通讯作者，Correspondingauthor，E-mail：wm-xmy@163．com
