肺血栓栓塞症合并下肢深静脉血栓临床分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

乔力松 ^1,2 , 许小毛 ¹ , 杨鹤 ¹ ,  李燕明 ^1,2

1. ;
2. ;

Corresponding author：

李燕明, Email: lymyl@263.net

Keywords：

肺血栓栓塞症; 深静脉血栓形成; 静脉血栓栓塞症

DOI：

10.7507/1671-6205.202012043

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目的探讨肺血栓栓塞症患者合并下肢深静脉血栓（DVT）临床特征。方法对 2009 年 1 月至 2018 年 5 月北京医院收治的 343 例急性肺血栓栓塞症（PTE）患者的临床资料进行回顾性分析，根据合并下肢 DVT 情况分为近端 DVT 组、单纯下肢远端 DVT（IDDVT）组和无 DVT 组。比较各组临床特征及预后情况。结果 343 例 PTE 患者平均（68.2±13.0）岁，男 165 例（48.1%）。158 例（46.1%）合并 DVT，其中下肢近端 DVT 91 例（57.6%），IDDVT 67 例（42.4%）。伴下肢 DVT 相关症状者 137 例（39.9%）中，检出 DVT 79 例（57.7%）。近端 DVT 组伴 DVT 相关症状的比例显著高于另两组（P=0.002 和 P<0.001）。近端 DVT 和 IDDVT 组白细胞及 D-二聚体水平显著高于非 DVT 组（均 P<0.05）。近端 DVT 组溶栓、置入下腔静脉滤器的比例均显著高于非 DVT 组（均 P<0.05），近端 DVT 组及 IDDVT 组低危 PTE 的比例显著低于无 DVT 组（P=0.042 和 P=0.013）。三组住院病死率差异无统计学意义（均 P>0.05）。多因素 Logistic 回归分析显示，目前吸烟（OR=2.96，95%CI 1.44～6.09，P=0.003）、DVT 病史（OR=2.27，95%CI 1.09～4.70，P=0.028）、DVT 症状（OR=3.26，95%CI 1.86～5.69，P<0.001）、D-二聚体>500 ng/mL（OR=4.47，95%CI 2.25～8.86，P<0.001）是 PTE 患者合并近端 DVT 的独立危险因素。DVT 病史（OR=7.27，95%CI 2.87～18.43，P<0.001）、脑血管病（OR=2.49，95%CI 1.07～5.76，P=0.033）、D-二聚体>500 ng/mL（OR=2.50，95%CI 1.30～4.82，P=0.006）是 PTE 患者合并 IDDVT 的独立危险因素。结论急性 PTE 患者伴发下肢 DVT 的比例接近 50%，其中超过一半为下肢近端 DVT。依据临床症状诊断 DVT 的可靠性较低，DVT 病史和 D-二聚体>500 pg/mL 是 PTE 患者合并下肢近端和远端 DVT 的独立危险因素。

Citation： 乔力松, 许小毛, 杨鹤, 李燕明. 肺血栓栓塞症合并下肢深静脉血栓临床分析. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(7): 509-512. doi: 10.7507/1671-6205.202012043 Copy

1.	中华医学会呼吸病血分会肺栓塞与肺血管病学组、中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会、全肺栓塞与肺血管病防治协作组. 肺血栓栓塞症诊治与预防指南. 中华医学杂志, 2018, 98(14): 1060-1088.
2.	van Rossum AB, van Houwelingen HC, Kieft GJ, et al. Prevalence of deep vein thrombosis in suspected and proven pulmonary embolism: a meta-analysis. Br J Radiol, 1998, 71(852): 1260-1265.
3.	Becattini C, Cohen AT, Agnelli G, et al. Risk stratification of patients with acute symptomatic pulmonary embolism based on presence or absence of lower extremity DVT: systematic review and meta-analysis. Chest, 2016, 149(1): 192-200.
4.	Bates SM, Jaeschke R, Stevens SM, et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9^th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e351S-e418S.
5.	Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35(43): 3033-3069.
6.	Jiménez D, Aujesky D, Díaz G, et al. Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism. Am J Respir Crit Care Med, 2010, 181(9): 983-991.
7.	Girard P, Sanchez O, Leroyer C, et al. Deep venous thrombosis in patients with acute pulmonary embolism: prevalence, risk factors, and clinical significance. Chest, 2005, 128(3): 1593-1600.
8.	Yamaki T, Nozaki M, Sakurai H, et al. Uses of different D-dimer levels can reduce the need for venous duplex scanning to rule out deep vein thrombosis in patients with symptomatic pulmonary embolism. J Vasc Surg, 2007, 46(3): 526-532.
9.	Yamaki T, Nozaki M, Sakurai H, et al. Presence of lower limb deep vein thrombosis and prognosis in patients with symptomatic pulmonary embolism: preliminary report. Eur J Vasc Endovasc Surg, 2009, 37(2): 225-231.
10.	Kearon C. Natural history of venous thromboembolism. Circulation, 2003, 107(23 Suppl 1): I22-I30.
11.	Hirmerova J, Seidlerova J, Chudacek Z. The prevalence of concomitant deep vein thrombosis, symptomatic or asymptomatic, proximal or distal, in patients with symptomatic pulmonary embolism. Clin Appl Thromb Hemost, 2018, 24(8): 1352-1357.
12.	Bertoletti L, Quenet S, Mismetti P, et al. Clinical presentation and outcome of venous thromboembolism in COPD. Eur Respir J, 2012, 39(4): 862-868.

1. 中华医学会呼吸病血分会肺栓塞与肺血管病学组、中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会、全肺栓塞与肺血管病防治协作组. 肺血栓栓塞症诊治与预防指南. 中华医学杂志, 2018, 98(14): 1060-1088.
2. van Rossum AB, van Houwelingen HC, Kieft GJ, et al. Prevalence of deep vein thrombosis in suspected and proven pulmonary embolism: a meta-analysis. Br J Radiol, 1998, 71(852): 1260-1265.
3. Becattini C, Cohen AT, Agnelli G, et al. Risk stratification of patients with acute symptomatic pulmonary embolism based on presence or absence of lower extremity DVT: systematic review and meta-analysis. Chest, 2016, 149(1): 192-200.
4. Bates SM, Jaeschke R, Stevens SM, et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9^th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e351S-e418S.
5. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35(43): 3033-3069.
6. Jiménez D, Aujesky D, Díaz G, et al. Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism. Am J Respir Crit Care Med, 2010, 181(9): 983-991.
7. Girard P, Sanchez O, Leroyer C, et al. Deep venous thrombosis in patients with acute pulmonary embolism: prevalence, risk factors, and clinical significance. Chest, 2005, 128(3): 1593-1600.
8. Yamaki T, Nozaki M, Sakurai H, et al. Uses of different D-dimer levels can reduce the need for venous duplex scanning to rule out deep vein thrombosis in patients with symptomatic pulmonary embolism. J Vasc Surg, 2007, 46(3): 526-532.
9. Yamaki T, Nozaki M, Sakurai H, et al. Presence of lower limb deep vein thrombosis and prognosis in patients with symptomatic pulmonary embolism: preliminary report. Eur J Vasc Endovasc Surg, 2009, 37(2): 225-231.
10. Kearon C. Natural history of venous thromboembolism. Circulation, 2003, 107(23 Suppl 1): I22-I30.
11. Hirmerova J, Seidlerova J, Chudacek Z. The prevalence of concomitant deep vein thrombosis, symptomatic or asymptomatic, proximal or distal, in patients with symptomatic pulmonary embolism. Clin Appl Thromb Hemost, 2018, 24(8): 1352-1357.
12. Bertoletti L, Quenet S, Mismetti P, et al. Clinical presentation and outcome of venous thromboembolism in COPD. Eur Respir J, 2012, 39(4): 862-868.

Chinese Journal of Respiratory and Critical Care Medicine

肺血栓栓塞症合并下肢深静脉血栓临床分析

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