再发性肺栓塞的危险因素分析

发布时间：2018-02-13 09:57

本文关键词： 肺栓塞再发性肺栓塞特发性肺栓塞危险因素预后　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:再发性肺栓塞是严重影响肺栓塞患者预后和生存质量的不良事件。本文通过分析患者的临床资料,探讨再发性肺栓塞的危险因素,以期识别可能复发的高危患者,为早期干预提供科学依据。方法:回顾性分析自2008年1月至2015年12月期间在青岛大学附属医院确诊的658例初发肺栓塞患者的临床资料,根据患者是否出现肺栓塞再发事件,将其划分为再发组和非再发组,分析两组间在性别、合并症/危险因素、残余血栓、实验室检查资料和影像学资料等方面是否有差异。采用t检验、χ2检验及非参数检验分析后,对可能有意义的因素再行多因素Logistic回归分析,筛选出再发性肺栓塞的独立危险因素。结果:658例肺栓塞患者中共有80例(12.16%)患者出现再发事件。80例再发患者中1年以内出现再发事件例数最多,其中又以6-12月为著。合并症/危险因素方面:肺栓塞再发组合并恶性肿瘤者占25%,非再发组合并恶性肿瘤者占13.8%,恶性肿瘤在两组间差异具有统计学意义(χ2=6.790,P=0.009)。临床症状、体征方面:较非再发组患者而言,肺栓塞再发患者出现呼吸困难(58.8%vs 44.3%,P=0.015)较为常见。实验室资料方面:血尿酸升高可能是肺栓塞再发的危险因素(P=0.001)。影像学资料方面:肺栓塞再发组与非再发组在右室扩大(χ2=4.476,P=0.034)、右房扩大(χ2=4.049,P=0.043)及重度肺动脉高压(χ2=5.041,P=0.025)方面具有统计学差异。早期死亡风险方面:对于区分肺栓塞是否再发,肺栓塞早期死亡风险分层表现为组内有统计学意义(χ2=13.774,P=0.03)。肺栓塞患者是否再发在低度死亡风险与中度死亡风险间有统计学差异(χ2=10.449,P=0.001)。残余血栓方面:再发患者中残余血栓的发生率为65.3%,非再发患者中残余血栓的发生率为45.1%。再发组发生残余血栓的可能性较大(χ2=9.754,P=0.002)。按照患者复查CTPA的时间分析显示3个月后两组间在残余血栓方面差异有统计学意义(χ2=10.254,P=0.001)。心脏超声表现为右心室扩大(c2=4.584,P=0.032)、重度肺动脉高压(c2=10.809,P=0.001)及下肢静脉超声表现为下肢深静脉血栓形成(c2=6.176,P=0.013)可能为残余血栓的危险因素。658例肺栓塞中特发性肺栓塞占17.5%。与非特发性肺栓塞相比,特发性肺栓塞出现再发事件较为常见(25.2%vs9.4%,P=0.000)。特发性肺栓塞发病年龄较非特发性肺栓塞年轻[(52.95±17.27)vs(62.71±13.99),P0.05]。特发性肺栓塞患者右心室扩大(χ2=6.054,P=0.014)、重度肺动脉高压(χ2=16.467,P=0.000)较常见,且出现残余血栓的比例高于非特发性肺栓塞(67.5%vs44.2%,P=0.000)。再发性肺栓塞的独立危险因素有恶性肿瘤(OR:2.952,95%CI:1.503-5.797),特发性肺栓塞(OR:2.852,95%CI:1.510-5.387),血尿酸水平(OR:1.003,95%CI:1.001-1.005)和残余血栓(OR:1.811,95%CI:1.017-3.226)。结论:再发性肺栓塞的独立危险因素有合并恶性肿瘤、特发性肺栓塞、血尿酸水平和残余血栓。右心室扩大、重度肺动脉高压及下肢深静脉血栓形成可能是残余血栓的危险因素。与非特发性肺栓塞相比,特发性肺栓塞患者发病年龄较轻,右心室扩大、重度肺动脉压较为常见,发生残余血栓的风险较高。
[Abstract]:Objective : To study the risk factors of recurrent pulmonary embolism by analyzing the clinical data of patients with pulmonary embolism . In terms of clinical symptoms and signs : dyspnea ( 58 . 8 % vs 44.3 % , P = 0.015 ) was more common in patients with recurrent pulmonary embolism ( P = 0 . 015 ) . There was a statistically significant difference between the risk of low mortality and the risk of moderate death in patients with pulmonary embolism ( 蠂2 = 10.449 , P = 0.001 ) . Residual thrombosis : The incidence of residual thrombosis in recurrent patients was 65.3 % , and the incidence of residual thrombosis in non - recurrent patients was 45.1 % . There was a large possibility of residual thrombosis in the recurrence group ( 蠂2 = 9.754 , P = 0.002 ) . The time analysis of CTPA was performed in accordance with the patient ' s time analysis showing statistically significant differences in residual thrombus between the two groups after 3 months ( 蠂2 = 10.254 , P = 0.001 ) . Heart ultrasound showed right ventricular enlargement ( c2 = 4.584 , P = 0.032 ) , severe pulmonary hypertension ( c2 = 10.809 , P = 0.001 ) , and lower extremity venous ultrasound ( c2 = 6.176 , P = 0.013 ) may be a risk factor for residual thrombosis . There were 658 cases of idiopathic pulmonary embolism ( 17.5 % vs 9.4 % , P = 0.000 ) . The incidence of idiopathic pulmonary embolism was ( 52.95 卤 17.27 ) vs ( 62.71 卤 13.99 ) , P < 0.05 ) . The right ventricular enlargement in patients with idiopathic pulmonary embolism ( 蠂 ~ 2 = 6.54 , P = 0.014 ) , severe pulmonary hypertension ( 蠂 ~ 2 = 16.467 , P = 0.000 ) were more common , and the proportion of residual thrombosis was higher than that of non - idiopathic pulmonary embolism ( 67.5 % vs 44.2 % , P = 0.000 ) . The independent risk factors for recurrent pulmonary embolism were malignancy ( OR : 2.952 , 95 % CI : 1.503 - 5.797 ) , idiopathic pulmonary embolism ( OR : 2.852 , 95 % CI : 1.510 - 5.387 ) , blood uric acid level ( OR : 1.003 , 95 % CI : 1.001 - 1.005 ) and residual thrombus ( OR : 1.811 , 95 % CI : 1.017 - 3.226 ) . Conclusion : The independent risk factors of recurrent pulmonary embolism include complicated malignant tumor , idiopathic pulmonary embolism , blood uric acid level and residual thrombus . Right ventricle enlargement , severe pulmonary hypertension and deep venous thrombosis of lower limb may be the risk factors of residual thrombus . Compared with non - idiopathic pulmonary embolism , the incidence of idiopathic pulmonary embolism is lighter , right ventricle is enlarged , severe pulmonary artery pressure is more common , and the risk of residual thrombosis is high .

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.5

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