摘要目的:了解社区获得性肺炎（CAP）合并急性肺栓塞患者的临床特征，有助于及早识别高危患者。方法:回顾性收集北京大学人民医院2012年1月至2017年12月住院治疗的明确诊断CAP合并急性肺栓塞的患者39例（A组），按照性别、年龄匹配的原则以1∶2的比例收集同期住院治疗的单纯社区获得性肺炎患者78例（B组）。分析两组患者的人口学特征、发病时间、临床特点、实验室检查及胸部影像学等临床资料。应用配对资料的卡方检验、秩和检验及logistic回归分析进行对比分析。结果:A组患者呼吸困难发生率为21/39，高于B组（21/78），差异有统计学意义（ P=0.004）。A组合并心脏病史发生率为10/39，风湿免疫系统疾病史发生率为3/39，均高于B组（8/78， P=0.031；0/78， P=0.035）。A组D-二聚体为2 222（854，3 539） ng/ml，动脉血pH值为7.5±0.5，B型钠尿肽为103.9（48.7，236.8） pg/ml，下肢静脉血栓发生率为18/39，均高于B组［295（168，707）ng/ml， P<0.001；7.4±0.4， P=0.022；98.4（44.8，246.3） pg/ml， P=0.028；3/41， P<0.001］，A组PaCO 2为（35.3±6.2） mmHg（1 mmHg=0.133 kPa），低于B组［（38.4±4.4） mmHg， P=0.009］。logistic回归分析结果显示D-二聚体（ P=0.000）和呼吸困难（ P=0.033）与CAP合并肺栓塞风险相关。 结论:对合并呼吸困难的CAP患者，以及合并心脏病史或风湿免疫系统疾病史的患者，应警惕急性肺栓塞。血D-二聚体、动脉血pH值、PaCO 2、B型钠尿肽测定以及下肢静脉彩超检查对肺炎合并急性肺栓塞有提示作用。

abstractsObjective:To understanding the clinical characteristics of the patients of pneumonia concomitant with acute pulmonary embolism, and the early identification of high-risk patients.Methods:Retrospective analysis of hospitalized patients with confirmed diagnosis of community acquired pneumonia (CAP) with concomitant pulmonary embolism (PE) within a period of 5 years. Patients hospitalized with CAP alone in the same period were included in the control group in a ratio of 1∶2 according to the principle of gender and age. The demographic characteristics, clinical feature, laboratory examination, radiographic and other clinical data of these 2 groups of patients were studied. Statistical analysis was performed by Chi-square test, Kruskal-Wallis test and logistic regression.Results:Thirty-nine patients with CAP combined with PE and 78 patients with CAP alone were included. Compared to patients with CAP alone, dyspnea (21/39 vs 21/78, P=0.004), a history of heart disease (10/39 vs 8/78, P=0.031), and a history of connective tissue diseases (3/39 vs 0/78, P=0.035) were more common to seen in patients with CAP combined with PE. D-dimer [2 222(854, 3 539) ng/ml vs 295(168, 707) ng/ml, P=0.000], arterial PH value (7.5±0.5 vs 7.4±0.4, P=0.022), BNP [103.9(48.7, 236.8) pg/ml vs 98.4(44.8, 246.3) pg/ml, P=0.028] and incidence of lower extremity venous thrombosis (18/39 vs 3/41, P=0.000) were higher in patients with CAP combined with PE, while arterial partial pressure of CO 2 [(35.3±6.2) mmHg vs (38.4±4.4) mmHg, P=0.009, 1 mmHg=0.133 kPa] was lower. Logistic regression analysis showed that D-dimer ( P=0.000) and dyspnea ( P=0.033) were associated with the risk of PE. Conclusion:When patients with CAP represent dyspnea or have a history of heart disease or connective tissue diseases concomitant PE should be considered for differential diagnosis. Determination of D-dimer, arterial PH value, arterial partial pressure of CO 2, BNP and ultrasonography of lower extremities had important implications for the diagnosis of pneumonia complicated with acute pulmonary embolism.