肺栓塞患者治疗后炎症指标变化与血栓近期溶解的关系

doi:10.3969/j.issn.1002-1949.2018.10.004

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摘要目的研究PE患者WBC、中性粒细胞计数、淋巴细胞计数、NLR、PLR和血清IL-6水平治疗后14 d内的变化规律及其与血栓近期溶解效果的关系。方法前瞻性研究2015-06~2017-02三家医院呼吸内科经肺动脉CT血管造影（CTPA）首次确诊的PE患者，Mastora评分法评估治疗前后肺动脉阻塞指数（PAOI）。于治疗前24 h内及治疗后第1、3、7和14天检测WBC计数、中性粒细胞计数、淋巴细胞计数、NLR和PLR，于治疗前24 h内和治疗后第14天检测血清IL-6水平，描述上述炎症指标的变化规律及其与PAOI变化率的关系。结果本研究共纳入47例PE患者，WBC计数、中粒细胞计数治疗后持续下降，变化规律均符合二次方曲线模型（F分别为0.089、0.414，P均为0.000），不同时间点比较差异有统计学意义（F分别为22.149、25.118，P均为0.000）；淋巴细胞计数治疗后第1~3天上升，第3~7天平稳，第7~14天上升，变化规律符合二次方曲线模型（F=0.860，P=0.002），不同时间点比较差异有统计学意义（F=4.411，P=0.004）；NLR治疗后持续下降，变化规律符合三次方曲线模型（F=0.000，P=0.000），不同时间点比较差异有统计学意义（F=16.543，P=0.000）；PLR治疗后第1~3天下降，第3~7天上升，第7~14天平稳，变化规律不符合曲线模型，不同时间点比较差异无统计学意义（P＞0.05）。PE患者治疗后IL-6水平较前明显下降［(6.25±7.45)pg/mL vs.(25.14±25.97)pg/mL，P=0.000］。PE患者治疗前后PAOI变化率与治疗前NLR呈负相关（r=-0.352，P=0.015），与淋巴细胞计数呈正相关（r=0.335，P=0.021）。结论 PE治疗后NLR持续下降，淋巴细胞计数持续上升，提示PE炎症反应减弱，血栓溶解吸收。治疗前NLR、淋巴细胞计数与PAOI变化率有一定的相关性，可反映PE患者的近期血栓溶解效果。

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	周怀海
	秦志强
	覃少佳
	刘学冠
	陈桂荣
	冯广弘
	冯宗莲
	梁秋妹

关键词 ：肺栓塞（PE）, 肺动脉阻塞指数（PAOI）, 白细胞计数, 中性粒细胞计数, 淋巴细胞计数, 中性粒细胞/淋巴细胞比值(NLR), 血小板/淋巴细胞比值(PLR), 白细胞介素-6(IL-6)

基金资助:广西科技厅重大专项项目（桂科AB16380218）；广西卫计委科研课题（Z2015314）

通讯作者: 秦志强（1962-），男，博士，主任医师，硕士生导师，E-mail：qinzhiqiang148@sina.com。

作者简介: 周怀海（1990-），男，硕士研究生，住院医师, E-mail：326077089@qq.com。

引用本文:

周怀海，秦志强，覃少佳，刘学冠，陈桂荣，冯广弘，冯宗莲，梁秋妹. 肺栓塞患者治疗后炎症指标变化与血栓近期溶解的关系[J]. 中国急救医学, 2018, 38(10): 847-853.
Zhou Huai-hai, Qin Zhi-qiang, Qin Shao-jia, Liu Xue-guan, Chen Gui-rong, Feng Guang-hong, Feng Zong-lian, Liang Qiu-mei. Relations between inflammation biomarkers variation and short-term thrombus resolvation in patients with pulmonary embolism. Chinese Journal of Critical Care Medicine, 2018, 38(10): 847-853.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.10.004 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I10/847

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