诊断学理论与实践

诊断学理论与实践 ›› 2019, Vol. 18 ›› Issue (1): 37-43.doi: 10.16150/j.1671-2870.2019.01.008

• 论著 • 上一篇    下一篇

真实世界中肺栓塞后慢性血栓栓塞性肺动脉高压的发病及相关危险因素前瞻性研究

魏晓敏1, 张媛媛1, 董樑1, 夏敬文1, 龚益1,2, 喻永平3, 李圣青1   

  1. 1. 复旦大学附属华山医院呼吸与危重症医学科，上海 200040
    2. 复旦大学附属华山医院北院呼吸科，上海 201907
    3. 陕西师范大学医院呼吸内科，陕西 西安 710061
  • 收稿日期:2019-01-31 出版日期:2019-02-25 发布日期:2019-02-25

A prospective study on incidence of chronic thromboembolic pulmonary hypertension after pulmonary thromboembolism

WEI Xiaomin1, ZHANG Yuanyuan1, DONG Liang1, XIA Jingwen1, GONG Yi1,2, YU Yongping3, LI Shengqing1   

  1. 1. Department of Pulmonary and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
    2. Department of Respiratory, North Branch, Huashan University, Shanghai 201907, China
    3. Department of Respiratory, Affiliated Hospital, Shanxi Normal University, Shanxi Xi′an 710061, China
  • Received:2019-01-31 Online:2019-02-25 Published:2019-02-25

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摘要： 目的 分析初次诊断为肺栓塞症的患者，在接受足量且超过3个月的抗凝治疗后发生慢性血栓栓塞性肺动脉高压（chronic thromboembolic pulmonary hypertension，CTEPH）的发病率，并评估促使其发生CTEPH的潜在危险因素。方法 采取前瞻性研究方式，通过3年随访，评估初次诊断为肺栓塞的292例患者发展成为CTEPH的发病率及危险因素。结果 初次诊断为肺栓塞的292例患者发展成为CTEPH的累积发病率，在3个月时为9.20%，6个月为10.40%，1年为11.30%，2年为11.90%，3年为12.90%。发生CTEPH的危险因素包括，从出现肺栓塞症状到接受治疗的时间窗≥1个月（OR=9.065），肺栓塞危险程度分层为中危（OR=37.691）和重危患者（OR=33.957），肺血管分支和小分支存在血栓栓塞（OR=6.216），存在与肺栓塞发生相关的危险因素（OR=3.659）。结论 真实世界中，肺栓塞患者发生CTEPH的3年累积发病率较高，达12.90%，临床医师需重视。

关键词: 肺, 慢性血栓栓塞性肺动脉高压, 危险因素, 累积发病率

Abstract:

Objective: To explore the incidence of chronic thromboembolic pulmonary hypertension (CTEPH) in a series of patients with symptomatic pulmonary embolism(PE) diagnosed for the first time and receiving adequate anticoagulant treatment no less than 3 months, and to assess the risk factors of CTEPH in these patients. Methods: A prospective, long-term, 3 years follow-up study was conducted to assess the incidence and risk factors of CTEPH in 292 patients with PE diagnosed for the first time. Results: The cumulative incidence of CTEPH in 292 patients with PE diagnosed for the first time was 9.20% at three months, 10.40% at six months, 11.30% at one year, 11.90% at two years, and 12.90% at three years. The following factors increased the risk of CTEPH: time from symptoms to treatment of PE≥1 month (odds ratio OR=9.065), the intermediate risk PE (OR, 37.691) to high risk PE (OR=33.957); segmental and sub-segmental branch location of embolism (OR=6.216), the PE related primary risk factors (OR=3.659). Conclusions: The cumulative incidence of CTEPH in patients with PE is 12.90% at three years.CTEPH is a common complication in PE patients diagnosed for the first time.

Key words: pulmonary embolism, chronic thromboembolic pulmonary hypertension, risk factors, umulative incidence

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