急性肺栓塞患者深静脉血栓形成的 危险因素分析

目的 分析急性肺血栓栓塞(PTE)患者深静脉血栓形成(DVT)的临床危险因素.方法 资料来源于2002年6月至2004年12月入选肺栓塞溶栓与抗凝治疗多中心随机对照研究的454例患者.全部患者均经CT肺动脉造影和/或核素肺通气灌注扫描或磁共振肺动脉造影或直接肺动脉造影明确诊断为急性PTE.比较PTE有DVT与PTE无DVT的两组患者,筛选出PTE中DVT的危险因素.结果 对有DVT和无DVT患者,进行性别、年龄、BMI及基础疾病包括高血压、冠心病、慢性阻塞性肺疾病、糖尿病、脑卒中和肿瘤等比较,除糖尿病外(χ2=4.481,P=0.034),其余各指标在两组间的差异均无统计学意义.DVT的体征包括下肢水肿、静脉炎和双下肢周径差≥1 cm在两组间的差异均具有统计学意义(P＜0.01).通过logistic回归确定下肢水肿(OR=2.255;95%CI:1.493～3.408)、静脉炎(OR=2.380;95%CI:1.426～3.973)和双下肢周径差≥1 cm(OR=3.834;95%CI:2.561～5.738)是DVT的独立判断因素.结论 下肢水肿、静脉炎和双下肢周径差≥1 cm是DVT的危险因素.在临床工作中应注意检查DVT的体征,尤其应注意测量双下肢周径.

Study on the risk factors regarding deep venous thrombosis in acute pulmonary thromboembolism

Objective To identify the risk factors of deep venous thrombosis(DVT)in patients with acute pulmonary thromboembolism(PTE)+Methods Post hoc analysis on data from a prospective multicenter through a randomized control trial on thrombolysis and anticoagulant among 454 patients with acute symptomatic PTE from June 2002 to December 2004.All patients were confirmed PTE by CT pulmonary angiography(CTPA)and/or ventilation perfusion scan or by magnetic resonance pulmonary angiography.Data of PTE patients with DVT was compared with those without DVT to identify the DVT risk factors.The effect of other variable on DVT was assessed by logistic regression analysis.Results When comparing the age,sex body weight index and underlying diseases including hypertension,coronary heart disease,chronic obstructive pulmonary disease,cerebral accident and malignant tumor between groups of DVT and no DVT,data showed that there was no statistically significant difference except for diabetes(χ2=4.481,P=0.034)among them.However,results from multi-analysis showed that edema of lower-limb[odd ratio (OR),2.255;95% CI,1.493 to 3.408],phlebitis(OR,2.380;95% CI,1.426 to 3.973)and the entire swollen(calf swelling≥1 cm)larger than asymptomatic side(OR,3.834;95%CI,2.561 to 5.738)were independent risk factors for DVT.Conclusion Edema of lower-limb,phlebitis and calf swelling≥1 cm seemed to be risk factors for DVT.