肺栓塞合并下肢深静脉血栓危险因素分析
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摘要
(1)目的探讨不同栓子来源的肺栓塞(PTE)患者危险因素的差异,提高防治意识。(2)方法回顾性分析华北理工大学附属医院2015年9月~2017年9月诊治的202例PTE患者的临床资料,按栓子来源分为合并下肢深静脉血栓(DVT)组133例及不合并下肢DVT组69例,对两组患者的危险因素进行分析。(3)结果单因素分析显示糖尿病(P=0.014)、3天制动史(P=0.003)、3个月内创伤史(P=0.004)、口服避孕药(P=0.047)、右心增大(P=0.032)在合并下肢DVT的PTE患者中的发生率高于不合并者;而超重(P=0.020)更多见于不合并下肢DVT的PTE患者。多因素Logistic回归分析显示,3天制动史、糖尿病是PTE合并下肢DVT患者的危险因素。(4)结论糖尿病、3天内制动史提示PTE患者合并下肢DVT的风险性较大。
Objective To explore the risk factors of pulmonary embolism in different embolic sources,and to improve the awareness of prevention and treatment.Methods To analyzed the clinical data of 202 cases of pulmonary embolism in patients of North China University of Science and Technology Affiliated Hospital from September 2015 to September 2017,according to the source of embolic were divided into combined group of 133 cases of lower extremity deep venous thrombosis and with lower extremity deep venous thrombosis group 69 cases,the risk factors of the two groups were analyzed.Results The results of univariate analysis showed that diabetes mellitus(P =0.014),three days brake history(P =0.003),three months history of trauma(P =0.004),oral contraceptive pill(P =0.047),right heart enlargement(P =0.032),associated with patients with lower extremity DVT higher than patients with lower extremity DVT in patients with PTE,and overweight(P =0.020)more in patients with lower extremity DVT patients.Multivariate logisgic regression analysis revealed that three days brake history of immobilization and diabetes were risk factors for PTE in patients with lower extremity DVT.Conclusion Diabetes mellitus and three days brake history suggest that PTE patients with lower limb DVT are the risk factors.
Objective To explore the risk factors of pulmonary embolism in different embolic sources,and to improve the awareness of prevention and treatment.Methods To analyzed the clinical data of 202 cases of pulmonary embolism in patients of North China University of Science and Technology Affiliated Hospital from September 2015 to September 2017,according to the source of embolic were divided into combined group of 133 cases of lower extremity deep venous thrombosis and with lower extremity deep venous thrombosis group 69 cases,the risk factors of the two groups were analyzed.Results The results of univariate analysis showed that diabetes mellitus(P =0.014),three days brake history(P =0.003),three months history of trauma(P =0.004),oral contraceptive pill(P =0.047),right heart enlargement(P =0.032),associated with patients with lower extremity DVT higher than patients with lower extremity DVT in patients with PTE,and overweight(P =0.020)more in patients with lower extremity DVT patients.Multivariate logisgic regression analysis revealed that three days brake history of immobilization and diabetes were risk factors for PTE in patients with lower extremity DVT.Conclusion Diabetes mellitus and three days brake history suggest that PTE patients with lower limb DVT are the risk factors.
引文
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[2]Ghaye B,Willems V,Nchimi A,et al.Relationship between the extent of deep venous thrombosis and the extent of acute pulmonary embolism as assessed by CT angiography[J].Br J Radiol,2009,82(975):198-203
[3]Ogren M,Eriksson H,Bergqvist D,et al.Subcutaneous fat accumulation and BMI associated with risk for pulmonary embolism in patients with proximal deep vein thrombosis:apopulation study based on 23796consecutive autopsies[J].Intern Med,2005,258(2):166-171
[4]关振鹏,陈彦章,宋奕宁,等.体重指数及年龄对人工关节置换术后下肢深静脉血栓形成的影响[J].中国修复重建外科杂志,2006,32(6):611-615
[5]Lidegaard O,Lokkegaard E,Svendsen AL,et al.Hormonal contraception and risk of venous thromboembolism:national follow-up study[J].BMJ,2009,339:b2890
[6]Jardin F,Dubourg O,Bourdarias JP.Echocardiographic pattern of acute cor pulmonale[J].Chest,1997,111(1):209-217
[7]Jakhetiya A,Shukla NK,Deo SV,et al.Deep vein thrombosis in indian cancer patients undergoing major thoracic and abdomino-pelvic surgery[J].Indian J Surg Oncol,2016,7(4):425-429
[8]Kim YH,Kim JS.Incidence and natural history of deep-vein thrombosis after total knee arthroplasty.A prospective,randomised study[J].Bone Joint Surg Br,2002,84(4):566-570
[9]Giannotta M,Tapete G,Emmi G,et al.Thrombosis in inflammatory bowel diseases:what's the link?[J].Thromb J,2015,13:14
[10]Esmon CT.The interactions between inflammation and coagulation[J].Br J Haematol,2005,131(4):417-430
[11]李荣旭,孙爱东,井庆平.糖尿病并发下肢深静脉血栓形成诊治体会[J].山东医药,2007,47(22):101-102
[12]Cook MB,Dawsey SM,Diaw L,et al.Serum pepsinogens and helicobacter pylori in relation to the risk of esophageal squamous cell carcinoma in the alpha-tocopherol,beta-carotene cancer prevention study[J].Cancer Epidemiol Biomarkers Prev,2010,19(8):1966-1975
[13]Carr ME.Diabetes mellitus:a hypercoagulable state[J].Diabetes Complications,2001,15(1):44-54
[14]林广玲,邱树彬,林少晖.2型糖尿病与凝血功能障碍[J].中国血液流变学杂志,2005,15(1):86-87+94
[15]Hernndez-Espinosa D,Ord1ez A,Mi1ano A,et al.Hyperglycaemia impairs antithrombin secretion:possible contribution to the thrombotic risk of diabetes[J].Thromb Res,2009,124(4):483-489