老年慢性阻塞性肺疾病急性加重期继发肺栓塞和／或深静脉血栓的机制研究

目的：探讨老年慢性阻塞性肺疾病（ COPD）急性加重期继发肺栓塞（ PTE）和/或下肢静脉血栓形成（ DVT）的炎症机制。方法将上海市肺科医院2008年1月至2012年12月期间收治的26例老年高风险COPD急性加重期继发PTE和/或DVT的患者作为血栓组；另选择同期就诊于门诊的26例低风险COPD稳定期患者作为对照组。对入选患者的血常规、血黏度、血D-二聚体、纤维蛋白原、血气分析、外周血细胞因子、ESR、CRP进行对照分析。结果两组患者症状无特异性，以咳嗽、咳痰、胸闷、气促为主；血栓组患者血中性粒细胞百分比、D-二聚体、纤维蛋白原、IL-6、肿瘤坏死因子、CRP、ESR、低切和高切血黏度均值高于对照组（ t＝3.339、2.700、2.207、2.431、2.257、2.143、2.223、2.797，均P＜0.05），PaO2低于对照组（t＝4.312，P＜0.05）。血栓组患者外周血IL-6水平与D-二聚体、纤维蛋白原、低切血黏度呈正相关（r＝0.437、0.624、0.429，均P＜0.05）；血栓组患者外周血肿瘤坏死因子水平与纤维蛋白原、低切和高切血黏度呈正相关（r＝0.624、0.519、0.513，均P＜0.05）；血浆CRP与D-二聚体、纤维蛋白原、IL-6、肿瘤坏死因子呈正相关（r＝0.478、0.541、0.533、0.491，均P＜0.05）。结论老年高风险COPD患者急性加重期继发血栓性疾病存在显著的炎症反应；IL-6、肿瘤坏死因子可能在促进COPD急性加重期继发血栓疾病过程中起重要作用。

Mechanisms of pulmonary embolism and/or deep vein thrombosis secondary to chronic obstructive pulmonary disease exacerbation in elders

Objective To explore the inflammatory mechanisms of pulmonary embolism （ PTE ） and/or deep venous thrombosis （ DVT ） in elders secondary to chronic obstructive pulmonary disease （ COPD） exacerbation.Methods A total of 26 elders with acute exacerbation of high-risk COPD secondary PTE and/or DVT and 26 patients with low-risk COPD during stable phase diagnosed during the period of January 2008 to December 2012 were enrolled.The relevant parameters of routine blood examination , blood viscosity, D-dimer, fibrinogen （ FIB）, arterial blood gas, blood cytokine, erythrocyte sedimentation rate （ ESR ） and C-reactive protein （ CRP ） were retrospectively analyzed.Results The major nonspecific symptoms were cough, sputum and dyspnea.The mean of neutrophile percentage （N%）, D-dimer, FIB, interleukin-6 （IL-6）, tumor necrosis factor （TNF）, C-reactive protein （CRP）, low and high shear blood viscosity in blood samples of patients with acute exacerbation of high-risk COPD secondary PTE and （ or ） DVT were higher than those of the control group （ t =3.339, 2.700, 2.207, 2.431, 2.257, 2.143, 2.223, 2.797, all P〈0.05）.However arterial partial pressure of oxygen （ PaO2 ） was lower than that of lower-risk COPD patients （t=4.312, P〈0.05）.IL-6 in blood of patients with acute exacerbation of high-risk COPD secondary PTE and （ or） DVT was positively correlated with low-shear blood viscosity , D-dimer and FIB （r=0.437, 0.624, 0.429, all P〈0.05）.TNF in blood of patients with acute exacerbation of high-risk COPD secondary PTE and （ or ） DVT was positively correlated to FIB , low and high cut blood viscosity （ r =0.624, 0.519, 0.513, all P 〈0.05 ）.Plasma CRP in blood of patients with acute exacerbation of high-risk COPD secondary PTE and/or DVT was positively correlated with D-dimer, FIB, IL-6 and TNF （ r=0.478, 0.541, 0.533, 0.491, all P〈0.05）.Conclusions Inflammation may exist in elders with acute exacerbation of high-risk COPD secondary thrombotic disease.IL-6 and TNF may promote thrombosis secondary to acute exacerbation of COPD disease.Early screening and/or prophylactic anticoagulation are necessary for prevention.