探讨血浆D-二聚体、B型钠尿肽和血气(PaO₂、PaCO₂)在高风险慢性阻塞性肺疾病急性加重期(AECOPD)继发肺栓塞(PTE)的预测价值。

选取于2016年1月至2017年12月期间在我院住院的32例高风险AECOPD继发PTE的患者作为血栓组；同期住院60例高风险AECOPD未继发PTE的患者为高风险单纯COPD组；另选择同期住院的52例低风险AECOPD(未继发PTE)患者为低风险COPD组。对所有入选的患者行血浆D-二聚体、B型钠尿肽(BNP)及血气分析检查并进行对比分析。

高风险AECOPD患者(血栓组和高风险单纯COPD组)的血浆D-二聚体、BNP的均值均高于低风险COPD组患者，血栓组患者血浆D-二聚体均值又高于高风险单纯COPD组患者，差异均具有统计学意义(P<0.05)。血栓组患者的PaCO₂及PaO₂均值均低于高风险单纯COPD组及低风险COPD组患者，差异均具有统计学意义(P<0.05)。高风险单纯COPD组患者PaCO₂高于低风险COPD组患者(P<0.05)，但两组间PaO₂均值差异无统计学意义。

高风险AECOPD患者的血浆D-二聚体、BNP水平升高，低氧血症、二氧化碳潴留，继发肺栓塞时，D-二聚体及BNP升高更明显，低氧进一步加重，且在原有高二氧化碳水平的基础上出现PaCO₂下降，均值>5 mmHg，提示血浆D-二聚体、BNP与血气分析检测在判断高风险AECOPD继发肺栓塞的风险中有较高的预测价值，能为临床及时判断高风险AECOPD患者早期抗凝治疗提供重要的依据。

To investigate the predictive value of plasma D-dimmer, B-type natriuretic peptide (BNP) and blood gas indexes in secondary pulmonary thromboembolism (PTE) during the high-risk of acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

A total of 32 patients with high-risk AECOPD + secondary PTE, treated in our hospital from January 2016 to December 2017, were collected as the thrombosis group, 60 patients with high-risk of AECOPD without secondary PTE, treated at the same period, were selected as the simple high-risk COPD group, and 52 patients with low-risk COPD during the period of acute exacerbation (without secondary PTE), treated at the same period, were selected as the low-risk COPD group. The plasma D-dimmer, BNP, and blood gas indexes [the arterial partial pressure of oxygen (PaO₂) and the arterial partial pressure of carbon dioxide (PaCO₂)] were detected and analyzed in all the patients.

The mean values of plasma D-dimmer and BNP in the thrombosis group and the simple high-risk COPD group were higher than those of the low-risk COPD group. The mean value of plasma D-dimmer in the thrombosis group was higher than that of the high-risk COPD group, and statistical significant differences were found between the two groups (P<0.05). The PaCO₂ and PaO₂ in the thrombosis group were lower than those of the simple high-risk COPD group and the low-risk COPD group, and statistical significant differences were found between the two groups (P<0.05). The patients with simple high-risk COPD had higher PaCO₂ than the patients with low-risk COPD (P<0.05), however, there was no statistical significant difference in the mean PaO₂ between the two groups.

In the patients with high-risk AECOPD, the plasma D-dimmer and BNP levels are elevated, and hypoxemia and carbon dioxide retention occur. When combined with pulmonary thromboembolism, the D-dimmer and BNP levels increase more significantly, the symptoms of hypoxia are further aggravated. And on the basis of original high carbon dioxide, there is a decrease in the PaCO₂, with a mean value greater than 5 mm Hg, suggesting that the plasma D-dimmer, BNP, and blood gas analysis tests have a good predictive value in judging the high-risk AECOPD associated with pulmonary embolism. It can provide an important basis for early clinical anticoagulant therapy for the patients with acute exacerbation of high-risk COPD.