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。

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.