Department of Respiratory, The First Affiliated Hospital of Nanjing Medical University
目的 ：通过探讨老年急性肺血栓栓塞症（acute pulmonary thromboembolism, APTE）患者外周血白细胞（peripheral blood leukocytes, PBL）升高的相关因素及其预后意义，提高临床医生对APTE的认识。方法：收集南京医科大学第一附属医院2016年1月至2019年6月60岁以上老年住院APTE患者326例，分析患者PBL升高的原因及预后意义。采用Logistic回归方法，比较分析PBL升高组（n=78）和PBL正常组（n=248）患者的年龄、性别、D-二聚体水平、肺动脉栓塞部位、近端深静脉血栓（deep vein thrombosis, DVT）、远端DVT、基础疾病、深静脉置管、吸烟史、糖皮质激素应用。结果：下肢近端、远端均存在DVT病人PBL显著高于无DVT组和仅下肢远端DVT组（p<0.05）。统计学分析及Logistic回归分析均显示，心力衰竭、近期（<30天）骨折、间质性肺病和D-二聚体水平是老年APTE患者PBL升高的相关因素（p <0.05）。PBL升高组溶栓比例、在院死亡、血管活性药物使用、机械通气使用、心肺复苏率均高于PBL正常组病人（p<0.05）。结论：PBL升高的老年APTE患者预后较差，需要对心肺功能不全、下肢近端及远端均存在DVT的老年APTE患者重点关注。
Objective: To investigate the related factors and prognosis of peripheral blood leukocyte (PBL) in elderly patients with acute pulmonary thromboembolism (APTE). Methods: 326 elderly patients over 60 years old that were hospitalized and diagnosed APTE in the first affiliated Hospital of Nanjing Medical University from January 2016 to June 2019 were enrolled.. Patients were divided into elevated PBL group (n = 78) and normal PBL group (n = 248).. Logistic regression was used to analyze the factors associated to PBL elevation in elderly APTE patients, including the age, gender, D-dimer level, pulmonary embolism site, proximal DVT, distal DVT, basic diseases, deep venous catheterization, smoking history and glucocorticoid application. Results: The PBL in the group with proximal-distal lower extremity DVT was significantly higher than those in the group without DVT and the group with distal lower extremity DVT only (p< 0.05). The proportion of DVT in proximal lower extremity, chronic obstructive pulmonary disease, interstitial lung disease, heart failure, recent fracture, and the level of D-dimer in the elevated PBL group were higher than those in the normal PBL group (p<0.05). Statistical analysis and logistic regression analysis showed that heart failure, recent (< 30 days) fracture, interstitial lung disease, and D-dimer levels were associated factors of elevated PBL in elderly patients with APTE (p<0.05). The incidence of adverse events (including mortality in hospital, use of vasoactive drugs, use of mechanical ventilation, cardiopulmonary resuscitation, etc.) in the elevated PBL group was higher than that in the normal PBL group (p<0.05). Conclusion: The prognosis of elderly APTE patients with elevated PBL was worse. We need to pay more attention to elderly APTE patients with cardiac and pulmonary insufficiency and proximal-distal lower extremity DVT.