Objective: To investigate the clinical features of patients with atrial fibrillation (AF) and occult pulmonary embolism (PE). Methods: Clinical data of 67 AF patients complicated with PE (AP group) admitted to the Tianjin Chest hospital from January 2014 to July 2018 were analyzed. A total of 70 AF patients without PE served as the control group (AF group). The AP group was divided into 2 subgroups: AF with occult PE (OPE subgroup) and symptomatic PE (SPE subgroup). The clinical features of OPE subgroup were analyzed. Results: The levels of leukocyte counts, C-reactive protein, D-dimer and N-terminal pro-brain natriuretic peptide in the AP group were (7.4±2.7)×10(9)/L, 18.0 (5.9, 65.7) mg/L, 2.61 (1.63, 3.72) mg/L and 1 657 (600, 3 172)ng/L, which were higher than those in the AF group (P=0.008, P<0.001, P<0.001 and P=0.002, respectively); Arterial oxygen pressure in the AP group was (74±13) mmHg (1 mmHg=0.133 kPa), lower than the AF group (P<0.001); and pulmonary artery systolic pressure was (46±16) mmHg, higher than the AF group (P<0.001). In the OPE subgroup, 12 cases (66.7%) were complicated with localized pulmonary embolism, more than those in the SPE subgroup (P=0.008), and pulmonary artery systolic pressure was (39±11) mmHg, which was lower than the SPE subgroup (P<0.001); the levels of leukocyte counts, C-reactive protein and D-dimer in the OPE subgroup were (7.6±2.3)×10(9)/L, 18.3 (3.7, 67.3) mg/L and 2.31 (1.27, 3.61) mg/L, higher than the AF group (all P<0.05); arterial oxygen pressure in the OPE subgroup was (75±12) mmHg, lower than the AF group (P<0.05). Conclusions: Occult pulmonary embolism is not uncommon in patients with atrial fibrillation. Comparing with AF group, the OPE subgroup was associated with increased levels of inflammatory markers and D-dimer and hypoxemia.
目的： 分析心房颤动（房颤）合并隐匿性肺栓塞的临床特征。 方法： 回顾性分析天津市胸科医院2014年1月—2018年7月收治的67例房颤合并肺栓塞患者（房颤合并肺栓塞组）的临床资料，与70例不合并肺栓塞的单纯房颤患者（单纯房颤组）进行比较；根据患者的临床表现又将房颤合并肺栓塞组分为隐匿性肺栓塞组和症状性肺栓塞组，分析隐匿性肺栓塞患者的临床特征。 结果： 房颤合并肺栓塞组外周血白细胞计数、C-反应蛋白、D-二聚体、N端B性钠尿肽前体水平分别为（7.4±2.7）× 10(9)/L、18.0（5.9，65.7）mg/L、2.61（1.63，3.72）mg/L、1 657（600，3 172）ng/L，均显著高于单纯房颤组（分别为P=0.008，P<0.001，P<0.001和P=0.002）；动脉血氧分压为（74±13）mmHg（1 mmHg=0.133 kPa），低于单纯房颤组（P<0.001）；肺动脉收缩压为（46±16）mmHg，高于单纯房颤组（P<0.001）。隐匿性肺栓塞组12例（66.7%）为局限性肺栓塞，多于症状性肺栓塞组（P=0.008）；肺动脉收缩压为（39±11）mmHg，低于症状性肺栓塞组（P<0.001）；外周血白细胞计数、C-反应蛋白、D-二聚体水平分别为（7.6±2.3）×10(9)/L、18.3（3.7，67.3）mg/L、2.31（1.27，3.61）mg/L，均高于单纯房颤组（均P<0.05）；动脉血氧分压为（75±12）mmHg，低于单纯房颤组（P<0.05）。 结论： 房颤合并隐匿性肺栓塞并不少见，与单纯房颤相比，合并隐匿性肺栓塞患者炎症指标和D-二聚体升高而动脉血氧分压降低。.
Keywords: Atrial fibrillation; Disease attributes; Occult; Pulmonary embolism.