Clinical Analysis Of Interstitial Lung Disease Complicate With Pulmonary Embolism

Objective(s): In this study,by comparing the general data,clinical manifestations,past history,complications and related auxiliary examination data of patients with interstitial lung disease complicated with pulmonary embolism and simple interstitial lung disease,the clinical characteristics and risk factors of patients with interstitial lung disease complicated with pulmonary embolism were discussed in order to identify and intervene such patients as early as possible and improve the prognosis.Methods: A total of 147 patients with interstitial lung disease who underwent CTPA examination in the Second Affiliated Hospital of Kunming Medical University hospital from January 2017 to December 2021 were retrospectively collected.According to the inclusion and exclusion criteria,the patients were divided into interstitial lung disease with pulmonary embolism group(n = 61)and simple interstitial lung disease group(n = 86)according to the results of CTPA.SPSS25.0software was used to analyze the general data(age,gender,BMI,smoking history),clinical manifestations(cough,expectoration,hemoptysis,dyspnea,fever,palpitation,chest tightness,chest pain,fatigue,lower limb edema),past history and complications(hypertension,coronary heart disease,diabetes,rheumatic immune disease,glucocorticoid use history,respiratory failure,pleural effusion),imaging data(embolization site,echocardiographic parameters),laboratory indicators(blood cell analysis,coagulation function,acute infection,biochemical test indicators,myocardial injury markers)of the two groups of patients.The binary logistic regression model was constructed to find the independent influencing factors of interstitial lung disease complicated with pulmonary embolism.The receiver operating characteristic curve(ROC curve)was used to study the indicators with diagnostic value for pulmonary embolism,and the corresponding optimal critical value,sensitivity and specificity were calculated.Results:1.Comparison of general data between the two groups : The median age of patients in the interstitial lung disease with pulmonary embolism group was higher than that in the simple interstitial lung disease group(P = 0.000).There was no significant difference in gender,smoking history and BMI between the two groups(P > 0.05).2.Comparison of clinical manifestations between the two groups : The most common clinical manifestations of the two groups were cough,expectoration and dyspnea.There was no significant difference between the two groups in cough,expectoration,fever,hemoptysis,dyspnea,palpitation,chest pain,fatigue and edema of both lower limbs(P > 0.05).3.Comparison of past history and complications between the two groups : The incidence of respiratory failure(70.5 % vs.43.0 %,P = 0.001)and pleural effusion(39.3 % vs.22.1 %,P = 0.023)in the interstitial lung disease with pulmonary embolism group was higher than that in the simple interstitial lung disease group.There was no significant difference in the history of hypertension,diabetes,coronary heart disease,rheumatic immune disease and hormone use between the two groups(P > 0.05).4.Comparison of laboratory indicators between the two groups of patients : In univariate analysis,the levels of NEUT,NLR,PT,DD,PCT,IL-6,Hs-CRP,c Tn T and NT-pro BNP in patients with interstitial lung disease complicated with pulmonary embolism were higher than those in simple interstitial lung disease group,the difference was statistically significant(P < 0.05);the levels of LYMPH and ALB were lower than those in the simple interstitial lung disease group(P < 0.05).There was no significant difference in WBC,RBC,PLT,HGB,MONO,APTT,TT,FIB,ALT,AST,LDH,CK,CK-MB,MYO,TC,HDL-C and LDL-C between the two groups(P > 0.05)5.Comparison of echocardiographic parameters between the two groups : RVDD(P = 0.047)and SPAP(P = 0.020)in patients with interstitial lung disease complicated with pulmonary embolism were higher than those in patients with simple interstitial lung disease.There was no significant difference in LVDD,CO,LVEF and SV between the two groups(P > 0.05).6.Pulmonary embolism in patients with interstitial lung disease complicated with pulmonary embolism is more common in segments and subsegments;thirty-nine patients(64 %)were diagnosed with both interstitial lung disease and pulmonary embolism,10 patients(16 %)were diagnosed with pulmonary embolism within 6months of diagnosis of interstitial lung disease,and 12 patients(20 %)were diagnosed with pulmonary embolism after 6 months of diagnosis of interstitial lung disease.7.The mean or median of the measurement data with statistical differences were converted into binary data for univariate analysis : the proportion of elderly patients,DD,SPAP,c Tn T,NT-pro BNP,PCT,NLR and Hs-CRP in the interstitial lung disease with pulmonary embolism group was higher than that in the simple interstitial lung disease group,and the difference was statistically significant(P < 0.05).The proportion of ALB reduction was higher than that in the simple interstitial lung disease group,and the difference was statistically significant(P < 0.05).There was no significant difference in the distribution of NEUT,LYMPH,RVDD,PT and IL-6between the two groups(P > 0.05).8.Multivariate Logistic regression analysis showed that age(OR = 1.051,95 %CI : 1.013-1.091,P = 0.009),NLR(OR = 1.130,95 % CI : 1.000-1.277,P= 0.049),DD(OR = 1.133,95 % CI : 1.013-1.266,P= 0.029)had statistically significant effects on interstitial lung disease complicated with pulmonary embolism(P < 0.05).9.ROC receiver operating characteristic curve showed that age,DD and NLR had certain diagnostic value for interstitial lung disease complicated with pulmonary embolism,and the corresponding optimal critical values were 61.5 years,2.18 ug / ml,4.655;the sensitivity and specificity were(0.885,0.395),(0.377,0.895),(0.459,0.826),95 % CI were(0.583-0.756),(0.550-0.734),(0.543-0.730).The area under the curve was 0.669,0.642 and 0.636,respectively.The diagnostic value of combined detection of age,DD and NLR for pulmonary embolism was higher than that of single index.The corresponding area under the curve was 0.739,the critical value was 0.31,the sensitivity was 0.885,and the specificity was 0.512.Conclusion(s):1.Compared with patients with simple interstitial lung disease,patients with interstitial lung disease complicated with pulmonary embolism are older,and more complicated with respiratory failure and pleural effusion.2.Patients with interstitial lung disease complicated with pulmonary embolism were more likely to have decreased ALB and increased DD,SPAP,c Tn T,NT-pro BNP,PCT,NLR and Hs-CRP than patients with simple interstitial lung disease.3.Age,DD and NLR may be independent influencing factors of pulmonary embolism in patients with interstitial lung disease.The combined detection of the three has higher diagnostic value for pulmonary embolism.4.Pulmonary embolism in patients with interstitial lung disease complicated with pulmonary embolism is more common in segments and sub-segments.