慢性阻塞性肺疾病急性加重合并肺血栓栓塞症/肺原位血栓形成的危险因素

Risk factors for acute exacerbation of chronic obstructive pulmonary disease complicated by pulmonary thromboembolism/in situ pulmonary thrombosis

摘要

目的 探讨慢性阻塞性肺疾病急性加重（AECOPD）合并肺血栓栓塞症/肺原位血栓形成（PTE/PTS）的关联因素。方法 回顾性分析2013年1月至2023年12月期间福建医科大学附属第一医院诊断为AECOPD且完善CT肺动脉造影（CTPA）或核素肺通气/灌注显像（V/Q显像）的121例患者资料。根据影像学结果，将确诊PTE/PTS的44例患者作为PTE/PTS组，其余77例作为非PTE/PTS组。采用SPSS 27.0统计软件对两组患者的基础信息、合并症、临床表现及辅助检查结果进行对比分析。通过二元Logistic回归模型筛选PTE/PTS组的独立危险因素。采用受试者工作特征（ROC）曲线分析相关指标对PTE/PTS组的诊断效能。结果 两组在女性、年龄、高血压、下肢不对称肿胀、D-二聚体、肌钙蛋白I（cTnI）、脑利尿钠肽（BNP）、血红蛋白、下肢深静脉血栓形成（DVT）、右心扩大、肺动脉高压、胸腔积液方面差异有统计学意义（均P＜0.05）。多因素logistic回归分析结果显示，女性（OR=5.777，95%CI：1.667～20.027）、D-二聚体（OR=1.158，95%CI：1.015～1.322）、BNP（OR=1.001，95%CI：1.000～1.002）与AECOPD合并PTE/PTS相关。ROC曲线分析结果显示，D-二聚体的最佳临界值为0.565 mg/L（灵敏度86.4%，特异度49.4%），曲线下面积（AUC）为0.717（95%CI：0.626～0.808，P＜0.001）；BNP的最佳临界值为222 ng/L（灵敏度56.8%，特异度20.8%），AUC为0.702（95%CI：0.605～0.800，P＜0.001）；D-二聚体和BNP联合可提高预测效能（敏感度65.9%，特异度27.3%，AUC：0.753）。结论 女性、D-二聚体与BNP升高是AECOPD患者合并PTE/PTS的独立相关因素，具有诊断价值。对于疑似患者，联合检测D-二聚体和BNP可有效辅助筛查PTE/PTS，从而避免漏诊并及时启动抗凝治疗。

Abstract

Objective To investigate the associated factors of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by pulmonary thromboembolism/pulmonary thrombus formation (PTE/PTS). Methods A retrospective analysis was conducted on 121 patients diagnosed with AECOPD at the First Affiliated Hospital of Fujian Medical University between January 2013 and December 2023, who underwent complete computed tomography pulmonary angiography (CTPA) or radionuclide ventilation/perfusion (V/Q) imaging. Based on imaging findings, 44 patients diagnosed with PTE/PTS were assigned to the PTE/PTS group, while the remaining 77 patients formed the non-PTE/PTS group. SPSS 27.0 statistical software was used to compare baseline characteristics, comorbidities, clinical manifestations, and auxiliary examination results between the two groups. Binary logistic regression models were employed to identify independent risk factors for PTE/PTS group. Receiver operating characteristic (ROC) curve analysis evaluated the diagnostic performance of relevant indicators for PTE/PTS group. Results Significant differences existed between groups in female gender, age, hypertension, asymmetric lower limb edema, D-dimer, troponin I (cTnI), brain natriuretic peptide (BNP), hemoglobin (HGB), lower limb deep vein thrombosis (DVT), right heart enlargement, pulmonary hypertension, and pleural effusion (P ＜ 0.05). Multivariate logistic regression analysis revealed significant associations between female gender (OR = 5.777, 95%CI: 1.667 to 20.027), D-dimer (OR = 1.158, 95%CI: 1.015 to 1.322), BNP (OR = 1.001, 95%CI: 1.000 to 1.002), and AECOPD with PTE/PTS (P ＜ 0.05). ROC curve analysis results indicated that the optimal cutoff value for D-dimer was 0.565 mg/L (sensitivity 86.4%, specificity 49.4%), with an area under the curve (AUC) of 0.717 (95%CI: 0.626 to 0.808, P ＜ 0.001); The optimal cutoff for BNP was 222 ng/L (sensitivity 56.8%, specificity 20.8%), with an AUC of 0.702 (95%CI: 0.605 to 0.800, P ＜ 0.001). Combining D-dimer and BNP improved predictive performance (AUC = 0.753, 95%CI: 0.662 to 0.843), however, both sensitivity (65.9%) and specificity (27.3%) were limited. Conclusion Female gender, elevated D-dimer, and elevated BNP may be independent predictors of AECOPD complicated by PTE/PTS and hold diagnostic value. In patients with AECOPD, D-dimer serves as a sensitive screening marker for PTE/PTS, while BNP acts as an independent complementary predictor. Combined assessment of both markers improve predictive performance, however, the combined model exhibited low specificity and therefore cannot yet be directely applied for clinical stratification.

关键词

慢性阻塞性肺疾病急性加重 / 肺原位血栓形成 / 肺血栓栓塞症 / 危险因素

Key words

acute exacerbation of chronic obstructive pulmonary disease / in situ pulmonary thrombosis / pulmonary thromboembolism / risk factors

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基金资助

福建省老年医院老年医学科国家临床重点专科建设项目【2026】