| Objectives:With the increase in the detection rate of pulmonary embolism,the recurrence of pulmonary embolism is often found in some patients in clinical practice.This study will explore the short-term risk factors and clinical characteristics for recurrent pulmonary embolism,so as to provide information for identifying patients with recurrence in future clinic.Method:A retrospective analysis of patients who were diagnosed with pulmonary embolism by Computer Tomography Pulmonary Angiography(CTPA)from May 2015 to May 2018 in the Second Affiliated Hospital of Kunming Medical University,and were followed up for 2 years from the day of diagnosis,and at least return to the hospital for review during the follow-up period CTPA was performed twice,and the time for the first review was within half a year from the date of initial diagnosis.According to the definition of recurrence in the "Guidelines for the Diagnosis,Treatment and Prevention of Pulmonary embolism" issued by the Chinese Medical Association in 2018,the study subjects were divided into recurrence group and non-recurrence group.Collect the general information,clinical manifestations,past history,operation records,all diagnosis,anticoagulation treatment plan and duration.Collect the results of echocardiography,ultrasonography of the blood vessels of both lower extremities,as well as the results of coagulation function,D-dimer,biochemical,acute infection indicators,and myocardial injury markers,then calculate the CT obstruction index based on the CTPA results.Analyze the collected data according to the following steps:The first part compares the general conditions,comorbidities,and common risk factors of patients in the recurrence group and the non-recurrence group,the first clinical manifestations,obstruction area and extent,examination results,and the duration of anticoagulation therapy.In the second part,the indexes of the two groups were compared before and after the initial diagnosis and the recurrence(review),focusing on the characteristics of the recurrence group and the difference between the recurrence group and the non-recurrence group.The third part is based on the results of single factor analysis of the first two parts to conduct logistic analysis to explore the independent risk factors for short-term recurrence of pulmonary embolism.Results:A total of 240 subjects that met the inclusion criteria were grouped according to the definition of recurrence in the "Guidelines for the Diagnosis,Treatment and Prevention of Pulmonary embolism" issued by the Chinese Medical Association in 2018.There were 127 cases in the recurrence group and 113 cases in the non-recurrence group.The first part compares the data of patients in the recurrence group and the non-recurrence group.It is found that the only clinical manifestations with significant differences between the two groups are hemoptysis(P=0.Oil)and syncope(P=0.033).Recurrent patients are more likely to have the above-mentioned manifestations.Up to 20.4%of patients in the non-recurrence group did not have relevant clinical manifestations at the first diagnosis of pulmonary embolism,but were diagnosed through auxiliary examinations,which was significantly different from the recurrence group(P=0.017).Patients with a history of cancer(P=0.043)and a history of surgical treatment after the initial diagnosis were significantly higher in the recurrence rate(P=0.034).There were 8 cases(47.06%)with thrombus recurrence ≤6 months from the operation,6 cases(35.29%)with 7-12 months,and only 3 cases(17.65%)with more than 12 months,indicating a short period after operation the risk of recurrence is higher.At the same time,patients with recurrence are likely to cause pulmonary hypertension(P=0.013),and it is easy to merge with deep vein thrombosis of the lower limbs(P=0.004).The level of D-dimer in the recurrence group was significantly higher than that in the non-recurrence group(P<0.001).83.5%(106 cases)of the patients in the recurrence group were positive for D-dimer at the first diagnosis,while only 65.5%in the non-recurrence group(74 cases),both were significant(P=0.001).In terms of other laboratory tests,the troponin T(P=0.011),NT-proBNP(P=0.032),and LDH(P=0.043)of the patients in the recurrence group were higher than those in the non-recurrence group,and the difference was significant.The CT obstruction index(20%)of the recurrence group was significantly higher than that of the non-recurrence group(12.5%)(P=0.002),and the recurrence group had pulmonary artery embolism in 18.90%of patients,while the non-recurrence group was only 3.54%,there is a significant difference between the two groups(P<0.001).In terms of anticoagulation therapy,there were 53 cases(41.73%)and 51 cases(45.13%)in the recurrence group and the non-recurrence group with anticoagulation time ≥3 months,respectively,and there was no significant difference between the two groups(P>0.05).The distribution of recurrence time in the recurrence group was basically the same during the two-year period,and there was no statistical difference.In the second part,the indexes of the two groups were compared at the time of initial diagnosis and recurrence(review).72.44%of the patients in the recurrence group were still at a high level of pulmonary arterial pressure at the time of recurrence,while 56.64%of the patients in the non-recurrence group had pulmonary hypertension at both the time of review.There was no significant change in the incidence of pulmonary hypertension between the recurrence(re-examination)and the initial diagnosis in the two groups(P>0.05).Combined with the aforementioned incidence of pulmonary hypertension in patients with recurrence at the first diagnosis,the incidence of pulmonary hypertension was significantly higher than that of non-recurrence patients,suggesting that the incidence of pulmonary hypertension before and after recurrence was higher than that in the non-recurrence group.Deep vein thrombosis of the lower limbs accounted for 13.39%of patients with recurrence before and after,compared with only 1.77%in the non-recurrence group.In terms of D-dimer,there was no significant difference when they were first diagnosed and when they recurrenced,and they were both at a high level,and 74.02%of patients were continuously positive.However,the level of non-recurrence patients was significantly lower than that of the initial diagnosis(P=0.017),and 30.09%of patients had changed from positive to negative at the time of review,and 24.78%of patients continued to be negative for D-dimer during the entire course of the disease.Compared with the gold standard CTPA method,the sensitivity and specificity of D-dimer in assessing the recurrence of pulmonary embolism are 81.1%and 54.87%,respectively,the specificity is poor.When the patient is re-examined,it cannot be judged not to recurrence based on negative D-dimer alone.The third part is based on the results of the single factor analysis of the first two parts to conduct a logistic analysis.Operation(OR:4.101,95%CI 1.339-12.555,P=0.013),deep vein thrombosis of the lower extremities(OR:2.696,95%CI 1.080-6.730,P=0.034),persistent positive D-dimer(OR:4.705,95%CI 2.488-8.899,P<0.001),CT obstruction index(OR:11.123,95%CI 1.949-63.488,P=0.007)are risk factors for short-term recurrence of pulmonary embolism.Conclusions:1.Patients who are initially diagnosed with pulmonary embolism due to clinical manifestations of hemoptysis or syncope should be alert to the risk of recurrence of pulmonary embolism in the future.2.Patients with short-term recurrence of pulmonary embolism have the following clinical characteristics:most of them have a history of surgery and cancer.CT obstruction index is high,and the embolization position is located in the main pulmonary artery.In addition,pulmonary hypertension is prone to occur,and deep vein thrombosis of the lower extremities is prone to occur;D-dimer,troponin T,NT-proBNP,and LDH levels are relatively high at the first diagnosis.3.Prolonging the time of anticoagulant therapy cannot reduce the short-term recurrence rate of pulmonary embolism.4.The independent risk factors for short-term recurrence of pulmonary embolism are surgical history,combined with deep venous thrombosis of lower extremities,persistent positive D-dimer,and CT obstructive index. |
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