Objective To invesitgate the prevalence of pulmonary thromboembolism （PTE） in hospitalized patients with obstructive sleep apnea-hypopnea syndrome （OSAHS）from January 2004 to December 2008，and analyse its impact on the severity of OSAHS. Methods Demographic and clinical characteristics of 24 OSAHS patients complicated with PTE were analyzed. 30 OSAHS patients without PTE were served as controls. Results PTE was detected in 2.44% （31/1268） of the OSAHS patients. When compared with the OSAHS patients without PTE，the OSAHS patients with PTE had a significantly higher apnea hypopnea index （AHI） [（27.8±11.6）/h vs. （18.2±8.1）/h，P=0.038] and a lower LSpO2 （lowest saturated pulse arterial oxygen level） [（78.4±8.5）% vs. （85.2±7.9）%，P=0.035]. Both groups received continuous positive airway pressure （CPAP） ventilation. Anticoagulation and/or thrombolysis treatment were used in the OSAHS patients with PTE. Conclusions We found a higher prevalence of PTE in patients with OSAHS. Compared with those without PTE，OSAHS patients with PTE have more severe sleep apnea-hypopnea and hypoxemia in sleep. Comprehensive treatments including anticoagulation and CPAP should be used in these patients.
ObjectiveTo determine the ability of cardiopulmonary exercise testing (CPET) to distinguish chronic thromboembolic pulmonary hypertension (CTEPH) from chronic thromboembolic disease (CTED). MethodsFifty patients diagnosed with CTED and fifty-eight patients with CTEPH in the the First Affiliated Hospital of Guangzhou Medical University from April 2019 to February 2022 were retrospectively included. The basic characteristics including age, gender, body mass index, symptom duration, and N-terminal prohormone of brain natriuretic peptide (NTpro-BNP), parameters of arterial blood gas analysis, right heart catheterization, echocardiography, pulmonary function, and CPET were all compared between patients with CTED and those with CTEPH. ResultsPatients with CTEPH displayed longer symptom duration, increased NTpro-BNP, decreased arterial partial pressure of oxygen, larger right atrial and ventricular diameters, and impaired worse resting pulmonary diffusing function compared with those with CTED (P<0.05). However, there was no statistically significant difference in the resting pulmonary ventilation function between the two groups (P>0.05). Among the CPET parameters of the CTEPH group, peak exercise oxygen uptake per kilogram, oxygen uptake at anaerobic threshold, oxygen pulse, oxygen uptake efficiency slope and oxygen saturation were all decreased, while the minute ventilation-carbon dioxide production at anaerobic threshold (VE/VCO2@AT) and VE/VCO2 slope were increased (P<0.05). However, there was no statistically significant difference in heart rate reserve and breathing reserve (P>0.05). Furthermore, VE/VCO2@AT showed high accuracy for distinguishing CTEPH from CTED (sensitivity, 0.825; specificity, 0.860; and the area under the receiver operating characteristic curve 0.897). ConclusionsPatients with CTEPH showed more significant decreased exercise endurance, diffusion dysfunction, and hypoxemia during exercise and insufficient increase in cardiac output compared with CTED patients. Therefore, it is feasible to apply CPET as a new objective examination to distinguish CTED from CTEPH.
ObjectiveTo study the correlation between international normalized ratio (INR) and coagulation factor Ⅱ and Ⅹ in patients with pulmonary thromboembolism treated with warfarin at moderate and low intensity anticoagulation.MethodsFifty-one patients with pulmonary thromboembolism treated with warfarin orally were divided into low-intensity anticoagulation group (INR from 1.6 to 2.0) and standard-intensity anticoagulation group (INR form 2.0 to 3.0) according to their monitoring INR indices. The levels of coagulation factor Ⅱ and Ⅹ were measured, and the correlation between INR level and coagulation factor activity was compared.ResultsThe INR of the low intensity anticoagulation group was 1.69±0.2 and the standard intensity anticoagulation group was 2.55±0.46. The corresponding activity of coagulation factor Ⅱ was (48.3±28.0)% and (24.0±8.0)% respectively. The activity of coagulation factor Ⅹ was (32.8±24.0)% and (16.7±6.0)%. There was a negative correlation between the activity of INR and coagulation factor Ⅱ and Ⅹ, with correlation coefficients of –0.903 and –0.459, respectively. Coagulation factor Ⅱ activity < 40%, coagulation factor Ⅹ activity inhibitory level < 25% is defined as anticoagulation effect. When coagulation factor Ⅱ activity level reaches anticoagulation effect, the corresponding minimum INR value was 1.56 and as to coagulation factor Ⅹ, the corresponding minimum INR value was 1.66.ConclusionsINR is negatively correlated with the activity of coagulation factor Ⅱ and coagulation factor Ⅹ. With the increase of INR, the activity of coagulation factor Ⅱ and coagulation factor Ⅹ decrease. Low intensity anticoagulation could not effectively inhibit the activity of coagulation factor.
Objective Pulmonary thromboembolism ( PTE) is associated with various risk factors which existed in multidisciplinary patients. It is necessary to know what the role of pulmonologists in the diagnosis of PTE. Methods Data were collected from thirteen general hospitals in Guangxi. Hospital records of PTE cases from1995 to 2007 were retrospectively analyzed. The rates of PTE to inpatients between the respiratory departments and other departments or between different periods were compared. Results The rates of PTE of inpatients in respiratory departments ( 1. 55‰, 170/109 577) was higher than that in other departments ( 0. 03‰, 69/2 322 944) , P lt; 0. 001. Compared to that of 1995-2001, the rate of PTE of inpatients in the respiratory departments in the last 6 years increased by 3220. 22% [ ( 2. 43‰,167/68 638) vs ( 0. 07‰, 3 /40 939) ] . During 1995-2001 and 2002-2007, the rates of PTE of inpatients in the respiratory departments were higher than those in other departments [ 0. 004‰ ( 4/1 012 830) during 1995-2001 and 0. 05‰( 65 /1 310 114) during 2002-2007, respectively] , P lt; 0. 01. Conclusion pulmonologists play an important role in the diagnosis of PTE in the recent years.
ObjectiveTo observe the impact of obstructive sleep apnea-hyponea syndrome (OSAHS) on the severity of pulmonary thromboembolism (PTE) and its treatment strategies. MethodsPTE patients hospitalized in our department between January 2006 and December 2012 were screened for this study, including 16 patients with OSAHS and 20 patients without OSAHS, and the difference in clinical characteristics such as arterial blood gas, apnea-hypopnea index, lowest pulse oxygen saturation (LSpO2) and treatment methods were analyzed and compared between the two groups. ResultsAs compared to PTE patients without OSAHS, the age of patients was lower[(53.4±12.1), (64.5±9.8) years; P=0.005], while body mass index[(29.3±2.2), (26.1±3.3) kg/m2, P=0.002] and smoking index (150±24, 101±18; P<0.001) were higher in PTE patients with OSAHS. Additionally, significantly lower LSpO2[(71.7±8.3), (79.4±7.1) mm Hg (1 mm Hg=0.133 kPa); P=0.005] and more lung segments (8±3, 5±2; P=0.001) were involved in PTE patients with OSAHS. In this cohort, all patients received anticoagulation and/or thrombolysis treatment, but the rate of continuous positive airway pressure (CPAP) ventilation application was significantly higher in PTE patients with OSAHS. ConclusionPTE patients with OSAHS have relatively lower age but serious condition, and both anticoagulation and CPAP should be used in the clinical treatment.
Objective To compare the clinical efficacy and safety of thrombolysis with anticoagulation therapy for patients with acute sub-massive pulmonary thromboembolism. Methods The clinical data of 84 patients with acute sub-massive pulmonary thromboembolism were analyzed retrospectively, mainly focusing on the in-hospital efficacy and safety of thrombolysis and/ or anticoagulation. The efficacy was evaluated based on 6 grades: cured, markedly improved, improved, not changed, deteriorated and died. Results Among the 84 patients,49 patients received thrombolysis and sequential anticoagulation therapy( thrombolysis group) , 35 patients received anticoagulation therapy alone( anticoagulation group) . As compared with the anticoagulation group, the thrombolysis group had higher effective rate( defined as patients who were cured, markedly improved or improved, 81. 6% versus 54. 3%, P = 0. 007) , lower critical event occurrence ( defined as clinical condition deteriorated or died, 2. 0% versus 14. 3% , P = 0. 032) . There was no significant difference in bleeding rates between the two groups ( thrombolysis group 20. 4% versus anticoagulation group 14. 3% , P gt; 0. 05) . No major bleeding or intracranial hemorrhage occurred in any of the patients. Conclusions Thrombolysis therapy may be more effective than anticoagulation therapy alone in patients with acute sub-massive pulmonary thromboembolism, and thus warrants further prospective randomized control study in large population.
Objective To investigate the value of different imageology methods in the diagnosis of acute pulmonary thromboembolism (PTE).Methods 22 cases diagnosed acute PTE in the last two years were retrospectively analysed，including 4 cases diagnosed by clinical signs and symptoms who did not perform further examinations due to severity of the disease (2 cases confirmed by autopsy)，18 cases diagnosed by either two methods of computed tomographic pulmonary angiography (CTPA)，ultrasound，radioisotope scanning of lung and pulmonary arteriography.The diagnostic positive rate of different methods were measured.Results 15 of the 18 subjects were performed CTPA，with a positive rate of 80.0% (12/15).Nuclide detection was performed in 14 cases，in which 5 cases were performed simple pulmonary infusion scanning，9 cases by lung ventilation/perfusion scanning，resulted in a positive rate of 92.9% (13/14).10 cases were performed nuclide phlebography on the low extremity simultaneously，deep phlebothrombosis was found in 5 subjects，and unnormal formation of collateral circulation，blocked blood circulation，stenosis of lumens，and valve disfunction et al were found in other 5 cases.16 cases were performed heart color ultrasound detection，in which 2 were found normal，one was directly found thrombus，and the other 8 cases were found indirect manifestations of acute PTE，including right ventricular enlargement，pulmonary artery hypertension，tricuspid backstreaming et al，with a diagnosing rate of 56% (9/16).Deep phlebothrombosis was found in 6 of the 10 cases who were performed color Doppler ultrasonography on the lower extremity，and one was found with valve function impaired.Conclusions CTPA possesses high positive rate in diagnosing acute PTE with promptness，convenience and reliability，thus can be taken as the front-line detection device.Radioisotope scanning of lung associated with same-time phlebography on the low extremity also has fairly high positive rate to diagnosing acute PTE and make it easy.
Objective To analyze the risk factors and clinical characteristics of patients in Uyghur and Han nationalities with pulmonary thromboembolism (PTE), who were hospitalized in past 7 years in the First Affiliated Hospital of Xinjiang Medical University, so as to investigate differences of risk factors between two nationalities. Methods Through retrospective study, clinical characteristics of PTE patients hospitalized from 2004 to 2010 were analyzed. T-test and chi-square test were used to conduct statistic analysis. Results a) A total of 516 patients (mean age 58.7±14.8 years old) with complete clinical materials were included, of whom 360 were Han nationality (69.8%, mean age 63.5±15.5 years old) and 156 were Uyghur nationality (30.2%, mean age 52.8±14.3 years old). In Han nationality, the peak age of PTE onset was above 70 years of age, while in Uyghur nationality it was 60 to 69 years of age; b) No significant difference was found in the clinical characteristics between the two nationalities; and c) The commonly acquired risk factors for PET patients in both nationalities possibly were age at or over 40 years old, obesity, embolism history and hyperlipidemia. The main risk factor of PTE was obesity in Uyghur nationality, while that was smoking in Han nationality. Conclusion The most common acquired risk factors and basic diseases of PTE patients are probably the age at or over 40 years old, obesity, embolism history and hyperlipidemia, and obesity is commonly seen in Uyghur nationality. A large number of further case-control studies are needed to further confirm this conclusion.