| Part 1:Analysis of clinical characteristics and risk factors of pulmonary embolism and its severityObjective:To analyze the clinical characteristics and risk factors of pulmonary embolism(PE)of different severity,to evaluate the disease reasonably and to provide guidance for disease prevention and treatment.Methods:According to the inclusion and exclusion criteria,102 patients with PE diagnosed by way of computed tomography pulmonary angiography(CTPA)and 71 patients in the non-PE group(suspected pulmonary embolism)were retrospectively collected from January 2017 to September 2020.The pulmonary artery obstruction indexes(PAOI)were calculated based on Qanadli embolism index,by which thePE group was divided into the mild group(PAOI<30%)and the moderate to severe group(PAOI≥30%).The clinical symptoms,laboratory indicators and possible influencing factors were analyzed.Chi-square test was used for clinical symptoms and possible influencing factors.Mann-Whitney U test was used for laboratory indicators.The diagnostic value of continuous variables with differences between groups was evaluated by receiver operating characteristic(ROC)curve.For indicators with statistical differences between groups,logistic regression analysis was used to predict the risk factors and establish the clinical risk assessment model of PE.Results:(1)There were significant differences in incidences of cough(P=0.009),unilateral lower limb pain(P<0.001),smoking(P=0.002),diabetes(P=0.018),pneumonia(P<0.001),deep vein thrombosis(P<0.001),plasma D-dimer(P<0.001)and NT-proBNP(P<0.001)between the PE group and the non-PE group,while there was no significant difference in the incidence of hemoptysis,chest pain,syncope,dyspnea,hypertension and immobilization within 1 month(P>0.05).(2)There were significant differences in incidences of hemoptysis(P=0.024),syncope(P=0.021),unilateral lower limb pain(P=0.047)and D-dimer(P=0.009)between the mild group and the moderate to severe group,while there was no significant difference in cough,chest pain,dyspnea,smoking,hypertension,diabetes,pneumonia,deep vein thrombosis and NT-proBNP(P>0.05).(3)ROC curve analysis showed that the area under the curve of D-dimer and NT-proBNP in the evaluation of pulmonary embolism were 0.829(95%CI:0.734-0.865)and 0.736(95%CI:0.666～0.816),respectively;the sensitivities were 84.3%and 57.4%,respectively;the specificity were 71.8%and 83.1%,respectively.(4)Logistic regression analysis showed that the risk factors of pulmonary embolism patients compared with suspected pulmonary embolism patients were pneumonia and deep venous thrombosis,with OR values of 14.165,21.594,respectively.Conclusion:The diagnostic value of PE is limited only by clinical manifestations,the occurrence of complications such as diabetes,pneumonia,deep venous thrombosis,D-dimer and NT-proBNP contribute to the diagnosis of PE,and the severity of PE can be evaluated by clinical symptoms such as hemoptysis,syncope,unilateral lower limb pain and D-dimer.Among them,the risk of PE increased in patients with pneumonia and deep venous thrombosis.We should be on guard against suspected PE patients with related manifestations.Part 2:Risk Factors Evaluation of the Severity of Pulmonary Embolism Using Right Ventricular Function Parameters of CTPAObjective:To evaluate the risk factors of the severity of pulmonary embolism(PE)using the right ventricular function parameters of computed tomography pulmonary angiography(CTPA).Methods:According to the inclusion and exclusion criteria,60 patients with PE diagnosed by way of CTPA and 33 cases in the non-PE group(suspected pulmonary embolism)were retrospectively collected from September 2017 to April 2019.The pulmonary artery obstruction indexes(PAOI)were calculated based on Qanadli embolism index,by which thePE group was divided into the mild group(PAOI<30%)and the moderate to severe group(PAOI≥30%).T-test was used to compare the evaluation indexes of right ventricular function parameters among groups,including the ratio of maximum diameter of right ventricle and left ventricle(RVD/LVD),the diameter of pulmonary artery(DPA),the ratio of diameter of pulmonary artery and aorta(PA/AO),the diameter of azygos vein(DAV)and the diameter of superior vena cava(DSVC).The right ventricular function parameters were analyzed using the receiver operating characteristic(ROC)curve to evaluate the diagnostic efficacy of PE severity.Logistic regression analysis was performed on the above factors including the right ventricular function parameters,gender,and age to predict the risk factors of PE severity.Results:(1)The differences in RVD/LVD(P=0.001),DPA(P=0.036),DAV(P<0.001)and DSVC(P=0.019)between the PE group and the non-PE group were statistically significant,while the difference in PA/AO was not statistically significant(P>0.05).(2)DPA(P<0.001),PA/AO(P=0.001)and RVD/LVD(P=0.001)were significantly different while DAV and DSVC were not significantly different(P>0.05)between the mild group and the moderate to severe group.(3)ROC curve analysis showed that the areas under the curve of DPA,PA/AO,RVD/LVD for the evaluation of mild and moderate to severe PE were 0.834,0.771 and 0.726,respectively;the sensitivities were 83.33%,83.33%and 88.89%,respectively;the specificity were 71.43%,66.67%and 54.76%,respectively.(4)Logistic regression analysis showed that the risk factor of the moderate to severe group compared with the mild group was DPA(OR=127.13,P=0.002).Conclusion:Right ventricular function parameters were abnormal in patients with pulmonary embolism.CTPA could be used to evaluate the severity of PE by measuring DPA,PA/AO and RVD/LVD.The higher the DPA value was,the higher the incidence rate of moderate to severe pulmonary embolism was. |
