肺血栓栓塞癥合并下肢深靜脈血栓臨床分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

喬力松 ^1,2 , 許小毛 ¹ , 楊鶴 ¹ ,  李燕明 ^1,2

1. ;
2. ;

Corresponding?author：

李燕明, Email: lymyl@263.net

Keywords：

肺血栓栓塞癥; 深靜脈血栓形成; 靜脈血栓栓塞癥

DOI：

10.7507/1671-6205.202012043

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目的探討肺血栓栓塞癥患者合并下肢深靜脈血栓（DVT）臨床特征。方法對 2009 年 1 月至 2018 年 5 月北京醫院收治的 343 例急性肺血栓栓塞癥（PTE）患者的臨床資料進行回顧性分析，根據合并下肢 DVT 情況分為近端 DVT 組、單純下肢遠端 DVT（IDDVT）組和無 DVT 組。比較各組臨床特征及預后情況。結果 343 例 PTE 患者平均（68.2±13.0）歲，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 相關癥狀者 137 例（39.9%）中，檢出 DVT 79 例（57.7%）。近端 DVT 組伴 DVT 相關癥狀的比例顯著高于另兩組（P=0.002 和 P<0.001）。近端 DVT 和 IDDVT 組白細胞及 D-二聚體水平顯著高于非 DVT 組（均 P<0.05）。近端 DVT 組溶栓、置入下腔靜脈濾器的比例均顯著高于非 DVT 組（均 P<0.05），近端 DVT 組及 IDDVT 組低危 PTE 的比例顯著低于無 DVT 組（P=0.042 和 P=0.013）。三組住院病死率差異無統計學意義（均 P>0.05）。多因素 Logistic 回歸分析顯示，目前吸煙（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 癥狀（OR=3.26，95%CI 1.86～5.69，P<0.001）、D-二聚體>500 ng/mL（OR=4.47，95%CI 2.25～8.86，P<0.001）是 PTE 患者合并近端 DVT 的獨立危險因素。DVT 病史（OR=7.27，95%CI 2.87～18.43，P<0.001）、腦血管病（OR=2.49，95%CI 1.07～5.76，P=0.033）、D-二聚體>500 ng/mL（OR=2.50，95%CI 1.30～4.82，P=0.006）是 PTE 患者合并 IDDVT 的獨立危險因素。結論急性 PTE 患者伴發下肢 DVT 的比例接近 50%，其中超過一半為下肢近端 DVT。依據臨床癥狀診斷 DVT 的可靠性較低，DVT 病史和 D-二聚體>500 pg/mL 是 PTE 患者合并下肢近端和遠端 DVT 的獨立危險因素。

Citation： 喬力松, 許小毛, 楊鶴, 李燕明. 肺血栓栓塞癥合并下肢深靜脈血栓臨床分析. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(7): 509-512. doi: 10.7507/1671-6205.202012043 Copy

1.	中華醫學會呼吸病血分會肺栓塞與肺血管病學組、中國醫師協會呼吸醫師分會肺栓塞與肺血管病工作委員會、全肺栓塞與肺血管病防治協作組. 肺血栓栓塞癥診治與預防指南. 中華醫學雜志, 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. 中華醫學會呼吸病血分會肺栓塞與肺血管病學組、中國醫師協會呼吸醫師分會肺栓塞與肺血管病工作委員會、全肺栓塞與肺血管病防治協作組. 肺血栓栓塞癥診治與預防指南. 中華醫學雜志, 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

肺血栓栓塞癥合并下肢深靜脈血栓臨床分析

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