作者：刘畅，黎俊雅，朱忠立，胡健，祝国芸

单位：

中国人民解放军西部战区总医院重症医学科

Units：

Department of Intensive Care, Western Theater Command General Hospital of PLA, Chengdu 610083 , China

关键词：

肺栓塞; 静脉血栓栓塞; D-二聚体; N末端脑钠肽前体;

Keywords：

　Pulmonary embolism; Venous thromboembolism; D-dimer; N-terminal pro-brain natriuretic peptide

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.108

Funds：

四川省科技厅科研项目（2020YFSY0022）；

摘要：

目的 分析急性肺血栓栓塞症（PTE）患者复发静脉血栓栓塞（VTE）的危险因素。方法 回顾性选取2017年12月至2020年12月于中国人民解放军西部战区总医院接受治疗的急性PTE患者185例。根据患者出院后12个月是否复发VTE分为复发组（n=63）和非复发组（n=122）。收集患者一般资料、实验室检查指标。采用多因素Logistic回归分析探讨急性PTE患者复发VTE的影响因素。结果 复发组男性占比及年龄≥60岁、肥胖、合并高血压、合并糖尿病、接受溶栓治疗、出院前D-二聚体升高、出院前N末端脑钠肽前体（NT-proBNP）升高者占比高于非复发组（P<0.05）。多因素Logistic回归分析结果显示，男性[OR=1.542,95%CI(1.239,1.919)]、年龄≥60岁[OR=1.691,95%CI(1.336,2.140)]、肥胖[OR=1.482,95%CI(1.195,1.838)]、合并高血压[OR=1.862,95%CI(1.352,2.564)]、合并糖尿病[OR=1.592,95%CI(1.219,2.079)]、接受溶栓治疗[OR=1.711,95%CI(1.298,22.255)]、出院前D-二聚体升高[OR=1.352,95%CI(1.092,1.674)]、出院前NT-proBNP升高[OR=1.511,95%CI(1.259,1.813)]是急性PTE患者复发VTE的危险因素（P<0.05）。结论 男性、年龄≥60岁、肥胖、高血压、糖尿病、接受溶栓治疗及出院前D-二聚体≥1.0 mg/L、NT-proBNP≥450 ng/L是急性PTE患者复发VTE的危险因素。

Abstract：

　Objective To analyze the risk factors of recurrent venous thromboembolism (VTE) in patients with acutepulmonary thromboembolism (PTE) . Methods A total of 185 patients with acute PTE who received treatment in the WesternTheater Command General Hospital of PLA from December 2017 to December 2020 were retrospectively selected. Patients weredivided into relapsing group (n=63) and non-relapsing group (n=122) according to whether VTE recurred at 12 months afterdischarge. The general data and laboratory test indexes of patients were collected. Multivariate Logistic regression analysis wasused to investigate the influencing factors of recurrent VTE in patients with acute PTE. Results The proportion of male, and theproportion of patients with age ≥ 60 years old, obesity, hypertension, diabetes, thrombolytic therapy and increased D-dimer beforedischarge, increased N-terminal pro-brain natriuretic peptide (NT-proBNP) before discharge in the recurrence group were higherthan those in the non-recurrence group (P < 0.05) . Multivariate Logistic regression analysis showed that male [OR=1.542, 95%CI(1.239, 1.919) ] , age ≥ 60 years old [OR=1.691, 95%CI (1.336, 2.140) ] , obesity [OR=1.482, 95%CI (1.195, 1.838) ] , combinedhypertension [OR=1.862, 95%CI (1.352, 2.564) ] , combined diabetes [OR=1.592, 95%CI (1.219, 2.079) ] , receiving thrombolytictherapy [OR=1.711, 95%CI (1.298, 22.255) ] , D-dimer increasing before discharge [OR=1.352, 95%CI (1.092, 1.674) ] ,NT-proBNP increasing before discharge [OR=1.511, 95%CI (1.259, 1.813) ] were risk factors for recurrent VTE in acute PTEpatients (P < 0.05) . Conclusion Male, age ≥ 60 years old, obesity, hypertension, diabetes, D-dimer ≥ 1.0 mg/L and NT-proBNP≥ 450 ng/L before discharge are risk factors for recurrent VTE in patients with acute PTE.

ReferenceList：