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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

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  • 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

  网络出版日期: 2019-02-25

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

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  • 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 date: 2019-01-31

  Online published: 2019-02-25

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。

本文引用格式

魏晓敏, 张媛媛, 董樑, 夏敬文, 龚益, 喻永平, 李圣青 . 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[J]. 诊断学理论与实践, 2019 , 18(1) : 37 -43 . DOI: 10.16150/j.1671-2870.2019.01.008

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.

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