Efficacy and influencing factors of thrombolytic therapy in patients with pulmonary embolism complicated y pulmonary arterial hypertension.

Objective: To evaluate the therapeutic efficacy of thrombolysis in patients with pulmonary embolism (PE) and pulmonary hypertension (PH), and identify factors influencing therapeutic outcomes.

Methods: A retrospective analysis was conducted on 148 patients diagnosed with PE complicated by PH who received thrombolytic treatment at Tianjin Medical University General Hospital and Inner Mongolia People's Hospital between January 2022 and August 2024. Changes in inflammatory markers, blood gas parameters, and coagulation function indicators before and after treatment were compared, and the overall treatment efficacy rate was calculated. Patients were stratified based on therapeutic response, and a binary logistic regression model was employed to analyze factors associated with treatment effectiveness. The predictive value of these factors was assessed using receiver operating characteristic (ROC) curve analysis.

Results: Within 24 hours post-thrombolysis, primary symptoms and clinical signs significantly improved. Specifically, respiratory rate (RR), heart rate (HR), and partial pressure of carbon dioxide (PaCO₂) decreased significantly, whereas oxygen saturation (SaO₂) and partial pressure of oxygen (PaO₂) increased significantly. Additionally, there was a significant improvement in mean pulmonary artery pressure (MPAP) and right ventricular end-diastolic diameter (RVEDD). Among the patients, 27 demonstrated marked improvement, 81 showed improvement, and these were categorized as the effective group (n=108). The remaining 40 patients showed no improvement and were classified into the ineffective group (n=40). Binary Logistic regression analysis identified PaCO₂ <35 mmHg, D-dimer (D-D) ≥11 mg/L, interleukin-6 (IL-6) ≥24 pg/mL, and C-reactive protein (CRP) ≥16 mg/L as independent risk factors for ineffective thrombolysis in patients with PE and PH (all P<0.05). The areas under the curve (AUCs) for PaCO₂, D-D, IL-6, and CRP in predicting thrombolysis efficacy were 0.684, 0.655, 0.634, and 0.629, respectively.

Conclusion: Thrombolytic therapy effectively improves clinical symptoms, physical signs, hemodynamic parameters, and cardiac function in patients with PE complicated by PH. Furthermore, in clinical practice, early monitoring of inflammatory markers such as PaCO₂, D-D, IL-6, and CRP is crucial for timely adjustment and optimization of individualized therapeutic strategies.