Clinical Characteristics And Short-term Prognosis Of Metabolic Syndrome With Pulmonary Embolism

Objectives:The patients were divided into groups according to whether the patients were complicated with pulmonary embolism or metabolic syndrome.By studying the general data,inflammatory indexes,blood coagulation function,blood lipid level,liver and kidney function,embolic site,venous ultrasound of both lower extremities and the occurrence of adverse events within 30 days.To investigate the clinical characteristics of patients with MetS complicated with PE,to study whether MetS can be used as an independent predictor of PE and whether MetS and its components are related to the poor short-term prognosis of PE.Method:In this study,a retrospective study was conducted to collect the patients who were examined by CTPA in the inpatient department of the second affiliated Hospital of Kunming Medical University from January 2015 to December 2020.The general data,past history,CTPA results,lower extremity vein ultrasound,echocardiography,inflammation index,coagulation function,blood lipid level,liver and kidney function and other related indexes were collected.According to the inclusion and exclusion criteria,a total of 343 patients were enrolled in the group.It is divided into four parts:the first part is divided into two groups according to the occurrence of MetS in patients with PE,including 87 patients with both PE and MetS,in the case group and 124 patients with only PE in the PE group.The statistical differences in general condition,laboratory related indexes,location of pulmonary embolism,thrombosis of both lower extremities,short-term adverse events and prognosis between the two groups were compared;the second part was divided into two groups according to whether MetS patients were complicated with PE,including 87 patients with PE and MetS,in case group and 54 patients with MetS only in MetS group.The general condition,blood glucose,blood lipid and uric acid were compared between the two groups.In the third part,according to sPESI score,211 patients with PE were divided into low-risk group and medium-risk group,including 55 cases in low-risk group and 156cases in medium-risk group.In the fourth part,patients were divided into two groups according to the occurrence of PE,the patients were divided into two groups according to the occurrence of PE,the patients with PE were divided into two groups:group with PE and group without PE.There were 211 cases in group with PE and 132 cases in group without PE.The independent correlation between MetS and its constituent factors and the occurrence of PE was compared.Results:1.Comparison between case group and PE group1.1 Comparison of general data:the age,systolic blood pressure and diastolic blood pressure in the case group were significantly higher than those in the PE group(P<0.05),but there was no significant difference in sex composition,body temperature,heart rate and respiratory frequency(P>0.05).1.2 Comparison of some echocardiographic indexes:the level of LVDD in the case group was higher than that in the PE group,and there was significant difference between the two groups(P<0.05),but there was no significant difference in RVDD,EF,PV and PAP between the two groups(P>0.05).1.3 Comparison of some laboratory indexes:① partial coagulation indexes:there was no significant difference in the levels of DD,FIB and INR between the two groups(P>0.05).②some renal function indexes:the level of uric acid in the case group was significantly higher than that in the PE group(P<0.05),and there was no significant difference in creatinine and urea between the two groups(P>0.05).③some indexes of liver function:the levels of albumin and CHE in the case group were higher than those in the PE group(P<0.05),and there was no significant difference in ALT and AST(P>0.05).④inflammatory indexes:there was no significant difference in PCT,IL-6,hs-CRP and NLR between the two groups(P>0.05).⑤others:the level of hs-TNT in the case group was higher than that in the PE group,and the difference was statistically significant(P<0.05),but there was no significant difference in the level of NT-proBNP(P>0.05).1.4 Comparison of the location of pulmonary embolism:there was no significant difference in the left and right(left,right,bilateral)and anatomical sites(trunk,lobe,segment,subsegment,multiple)of pulmonary thromboembolism between the case group and the control group(P>0.05).1.5 Comparison of the occurrence of deep venous thrombosis of both lower extremities:there was no significant difference in the occurrence of deep venous thrombosis of lower extremities between the case group and the PE group(left,right,bilateral)(P>0.05).1.6 Comparison of sPESI score and risk stratification:The sPESI score and the corresponding risk stratification of the two groups were statistically analyzed,and there was no significant difference between the two groups(P>0.05).1.7 Comparison of adverse events:there were 15 adverse events in the case group and 13 in the PE group.Chi-square test showed that there was no significant difference between the two groups(P>0.05).2.Comparison between case group and MetS group2.1 Comparison of general data:the age,pulse and respiratory rate in the case group were higher than those in the MetS group,and the level of BMI in the case group was lower than that in the MetS group(P<0.05),but there was no significant difference in sex composition,body temperature,systolic blood pressure and diastolic blood pressure(P>0.05)2.2 Comparison of blood lipids,blood glucose and uric acid levels:the levels of triglyceride,HDL-C and apolipoprotein A1 in the case group were significantly lower than those in the MetS group(P<0.05),but there was no significant difference in total cholesterol,LDL-C,NONHDL,apolipoprotein a,apolipoprotein B,uric acid and blood glucose(P>0.05).3.Comparison of MetS and its components in PE risk stratification:patients with PE were divided into low-risk group and medium-risk group according to sPESI score.The levels of diastolic blood pressure,total cholesterol,LDL-C,NONHDL and apolipoprotein A1 in low-risk group were significantly higher than those in medium-risk group(P<0.05).However,there was no significant difference in MetS,diabetes,BMI,systolic blood pressure,triglyceride,HDL-C,apolipoprotein B and blood glucose(P>0.05).4.Influencing factors of pulmonary embolism:binary Logistic regression analysis showed that among the metabolic syndrome and its related factors,BMI(OR 1.362,95%CI 1.81-2.950,P=0.003),diastolic blood pressure(OR 0.990,95%CI 0.962-1.019,P=0.049),age(OR 1.071,95%CI 1.048-1.096,P<0.001),HDL-C OR 0.061,95%CI 0.006-0.654,P=0.021),and apolipoprotein A1(OR 0.001,95%CI 0.000-0.013,P<0.001)were related to the occurrence of pulmonary embolism,in which diastolic blood pressure,HDL-C,apolipoprotein A1 were protective factors,BMI and age were risk factors.Conclusions:1.Metabolic syndrome consolidated with pulmonary embolism groups in patients,whose albumin,choline esterase,hs-TNT levels are higher,triglycerides,HDL-C,and apolipoprotein A1 levels reduce;2.Metabolic syndrome has no significant effect on the location of thrombosis and deep vein formation of lower extremities in patients with pulmonary embolism;3.Metabolic syndrome has no significant effect on the short-term prognosis of patients with pulmonary embolism,but patients with high levels of diastolic blood pressure,total cholesterol,LDL-C,NONHDL,and apolipoprotein A1 have a better prognosis;4.Metabolic syndrome can not be regarded as an independent risk factor for pulmonary embolism,but BMI and age can be used as independent risk factors for pulmonary embolism.Diastolic blood pressure,HDL-C and apolipoprotein A1 are protective factors.