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目的探讨急性肺栓塞(acute pulmonary embolism,APE)抗凝治疗后残余血栓形成的危险因素。方法回顾性分析129例经抗凝治疗3个月以上的APE患者的临床资料,根据治疗后CT肺动脉造影结果分为血栓完全溶解组85例和残余血栓组44例,比较2组临床资料,分析残余血栓形成的独立危险因素。结果残余血栓组急性期纤维蛋白原水平[(4.01±1.12)g/L]、无明显诱因比例(93.2%)、右心室扩大发生率(38.6%)、中央型栓塞发生率(50.0%)、确诊时主肺动脉与主动脉直径比值>1发生率(45.5%)均高于完全溶解组[(3.43±0.93)g/L、77.6%、14.1%、27.1%、24.7%](P<0.05);多因素logistic回归分析显示,无明显诱发因素(OR=0.231,95%CI:0.062~0.861,P=0.029)、急性期纤维蛋白原水平升高(OR=1.958,95%CI:1.282~2.991,P=0.001)、右心室扩大(OR=5.696,95%CI:2.085~15.561,P=0.002)是残余血栓发生的独立危险因素。结论部分APE患者经抗凝治疗后血栓不能完全溶解,无明显诱发因素、急性期纤维蛋白原水平、右心室扩大是残余血栓的独立危险因素。
Objective To investigate the risk factors of residual thrombosis after anticoagulation therapy of acute pulmonary embolism (APE). Methods The clinical data of 129 patients with APE treated with anticoagulant therapy for more than 3 months were retrospectively analyzed. According to CT pulmonary angiography after treatment, 85 patients were divided into thrombus complete dissolution group and 44 residual thrombus group. The clinical data of two groups were compared and analyzed Independent risk factors for residual thrombosis. Results The level of fibrinogen in acute thrombosis group was (4.01 ± 1.12) g / L, with no significant predisposition (93.2%), right ventricular enlargement (38.6%) and central embolism (50.0%), The ratio of main pulmonary artery to aorta diameter> 1 (45.5%) at the time of diagnosis was higher than that of the complete dissolution group (3.43 ± 0.93g / L, 77.6%, 14.1%, 27.1%, 24.7% ; Multivariate logistic regression analysis showed no significant predisposing factors (OR = 0.231, 95% CI: 0.062-0.861, P = 0.029), acute fibrinogen levels increased (OR = 1.958, 95% CI: 1.282-2.991 , P = 0.001). Right ventricular enlargement (OR = 5.696, 95% CI: 2.085-15.561, P = 0.002) was an independent risk factor for residual thrombosis. Conclusion Some patients with APE after anticoagulant therapy can not be completely dissolved thrombus, no obvious predisposing factors, acute fibrinogen level, right ventricular expansion is an independent risk factor for residual thrombus.