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

doi:10.16150/j.1671-2870.2019.01.008

Abstract

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

CLC Number:

R563.5

WEI Xiaomin, ZHANG Yuanyuan, DONG Liang, XIA Jingwen, GONG Yi, YU Yongping, LI Shengqing. A prospective study on incidence of chronic thromboembolic pulmonary hypertension after pulmonary thromboembolism[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(1): 37-43.

Figures/Tables 7

References 21

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特征	肺栓塞患者（n=292）	无肺栓塞主要危险因素（n=120）	有肺栓塞主要危险因素（n=172）	P值
年龄	57.29±13.43	58.23±13.124	56.63±13.633	0.148秩和检验
女性	133（45.54%）	60（50.00%）	73(42.44%)	0.202
吸烟	134（45.89%）	48（40.00%）	86（50.00%）	0.092
DVT	225（77.05%）	88（73.33%）	137（79.65%）	0.207
治疗方法				0.054
溶栓治疗	13（4.45%）	2（1.67%）	11（6.40%）
低分子量肝素+华法林	279（95.55%）	118（98.33%）	161（93.60%）
腔静脉滤器植入	2（0.68%）	1（0.83%）	1（0.58%）	1.000Fisher检验

危险因素	暴露比
主要危险因素
Ⅴ因子增加	42/184（22.82%）
抗凝血酶缺乏	28/149（18.79%）
蛋白S缺乏	40/192（20.83%）
蛋白C缺乏	38/186（20.43%）
Ⅶ因子缺乏	34/181（18.78%）
Ⅷ因子升高	49/180（27.22%）
高同型半胱氨酸	134/257（52.14%）
抗心磷脂抗体	23/194（11.86%）
次要危险因素
男性	159/292（54.45%）
吸烟史	134/292（45.89%）
BMI≥25	105/292（35.96%）
输血史	22/292（7.53%）
VTE史	7/292（2.40%）
恶性肿瘤以及放化疗史	52/292（17.81%）
血液病史	48/292（16.44%）
传染病史	40/292（13.70%）
慢性肺病史	65/292（22.26%）
糖尿病史	24/292（8.22%）
慢性心血管病史	86/292（29.45%）
慢性肾病史	15/292（5.14%）
慢性肝病	15/292（5.14%）
结缔组织病	16/292（2.05%）
外科手术史	68/292（23.29%）
骨折固定史	52/292（17.81%）
怀孕	9/292（3.08%）
下肢静脉曲张	62/292（21.23%）
高血脂	69/292（23.63%）

特征	CTEPH患者总数（n=34）	没有肺栓塞主要危险因素（n=4）	有肺栓塞主要危险因素（n=30）	P值
年龄（岁）	55.44±14.04	53.25±10.24	55.73±14.59	0.745
女性（n）	21（61.76%）	3（75.00%）	18(60.00%)	1.000 Fisher检验
深静脉血栓（n）	20（58.82%）	3(75.00%)	17(56.67%)	0.627 Fisher检验
从有症状到诊断为肺栓塞的时间（月）	12.51±13.53	12.13±13.71	12.57±13.74	0.661 秩和检验

危险因素	CTEPH（N=34）	对照组（N=258）	OR值	OR值95%CI	P值
年龄≥56（%）	17(50.00%)	160(62.02%)	0.613	（0.299~1.255）	0.181 0
女性（%）	21(61.76%)	112(43.41%)	2.106	（1.011~4.388）	0.047 0
有肺栓塞症状到治疗时间窗≥1个月	29(85.29%)	106(41.09%)	8.317	（3.118~22.181）	<0.000 1
肺栓塞危险程度分层（%）
低度危险因素	1(2.94%)	132(51.16%)	1.000
中度危险因素	28(82.35%)	103(39.92%)	35.883	（4.802~268.140）	<0.000 1
重度危险因素	5(14.71)	23（8.92%）	28.696	（3.204~256.974）	0.003 0
血栓定植
主要分支	27（79.41%）	246（95.35%）	1.000
次级分支以及小分支	7（20.59%）	12（4.65% ）	5.315	（1.929~14.641）	0.001 0
存在肺栓塞主要危险因素	30（88.24%）	142（55.04%）	6.127	（2.098~17.893）	0.001 0
高同型半胱氨酸	26（76.47%）	107（41.47%）	4.182	（1.749~9.999）	0.001 0

危险因素	OR值	OR值95%CI	P值
肺栓塞症状到治疗时间窗<1个月	1.000
肺栓塞症状到治疗时间窗≥1个月	9.065	（3.113~26.396）	<0.000 1
肺栓塞危险程度分层
肺栓塞低度危险	1.000
肺栓塞中度危险	37.691	（4.893~290.320）	<0.000 1
肺栓塞重度危险	33.957	（3.363~342.825）	0.003 0
血栓定植部位
主要分支有血栓定植	1.000
次级分支以及小分支有血栓定植	6.216	（1.392~27.747）	0.017 0
肺栓塞发生相关危险因素
不存在肺栓塞相关危险因素	1.000
存在肺栓塞相关危险因素	3.659	（1.033~12.963）	0.044 0