Pulmonary Division, Istituti Clinici Scientifici Maugeri SpA SB Pavia, IRCCS, Institute of Bari, Bari, Italy.
Respiratory Diseases, University of Bari, Italy.
Acta Biomed. 2021 Jul 1;92(3):e2021210. doi: 10.23750/abm.v92i3.11258.
There are no studies investigating populations of patients with both pulmonary embolism and chronic obstructive pulmonary disease (PE-COPD) with and without deep venous thrombosis (DVT).
To define prevalence of DVT in COPD with PE and to compare characteristics of COPD patients who develop PE, with and without DVT. Secondly, we aimed to assess differences in the localization of PE among study groups. METHODS. 116 patients with PE were enrolled in a retrospective study. Clinical data as well as echocardiographic and lower limb ultrasonography records were collected for all subjects. Subjects were divided into two groups according to the presence of COPD: Group 1, 54 patients with diagnosis of PE without COPD and Group 2, 66 patients diagnosed of PE with COPD. Then, individuals of Group 2 were subdivided in two subgroups according to the presence (n=21) or absence (n=45) of DVT.
33% of patients with COPD and PE showed DVT. These subjects had higher PaCO2 and ejection fraction (p<0.05 for all) and higher percentage of chronic renal failure and diabetes mellitus compared to those without DVT (p<0.05 for all). Moreover, in COPD-PE patients with DVT, the most frequent localization was proximal (54% of total), whereas COPD-PE patients without DVT showed a more frequent segmental localization (60% of total). No difference was found in clinical presentation and blood-chemistry tests.
DVT was non-common in PE-COPD patients. Chronic renal failure, and type 2 diabetes mellitus are more frequent in PE-COPD patients with DVT, that showed a higher frequency of proximal localization, thereby indicating a greater risk of more severe clinical implications. Conversely, PE- COPD subjects without DVT showed a more frequent segmental localization and were less hypercapnic. PE should be taken into account in COPD with worsening of respiratory symptoms, also in absence of DVT.
目前尚无研究调查同时患有肺栓塞（PE）和慢性阻塞性肺疾病（COPD）并伴有和不伴有深静脉血栓形成（DVT）的患者人群。
确定 PE 合并 COPD 患者中 DVT 的患病率，并比较伴有和不伴有 DVT 的发生 PE 的 COPD 患者的特征。其次，我们旨在评估研究组之间 PE 定位的差异。
对 116 例 PE 患者进行回顾性研究。对所有患者采集临床数据以及超声心动图和下肢超声记录。根据是否患有 COPD 将患者分为两组：第 1 组为 54 例无 COPD 的 PE 患者，第 2 组为 66 例诊断为 PE 合并 COPD 的患者。然后，根据是否存在 DVT（n=21 或 n=45）将第 2 组患者进一步分为两组。
33%的 COPD 合并 PE 患者存在 DVT。与无 DVT 的患者相比，这些患者的 PaCO2 和射血分数更高（所有指标均为 p<0.05），慢性肾功能衰竭和糖尿病的比例更高（所有指标均为 p<0.05）。此外，在存在 DVT 的 COPD-PE 患者中，最常见的部位是近端（占总数的 54%），而无 DVT 的 COPD-PE 患者则更常见节段性定位（占总数的 60%）。在临床表现和血液化学检查方面无差异。
在 PE-COPD 患者中，DVT 并不常见。在存在 DVT 的 PE-COPD 患者中，慢性肾功能衰竭和 2 型糖尿病更为常见，且近端定位的频率更高，表明更严重的临床后果的风险更高。相反，无 DVT 的 PE-COPD 患者表现出更常见的节段性定位，且二氧化碳潴留程度较低。在 COPD 患者出现呼吸症状恶化时，即使没有 DVT，也应考虑到 PE。
