急性肺栓塞患者复发的危险因素分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

张鑫 ,  董丽霞 , 曹洁 , 韩雪娇

天津医科大学总医院呼吸与危重症医学科（天津 300052）;

Corresponding author：

董丽霞, Email: luckydonglixia@163.com

Keywords：

急性肺栓塞; 复发; 危险因素; 基础疾病

DOI：

10.7507/1671-6205.201801054

Video：

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目的探究急性肺栓塞（APE）患者复发的独立危险预测因素。方法先后纳入 2014 年 1 月至 2015 年 12 月天津医科大学总医院呼吸与危重症医学科住院患者中首诊的 APE 患者 169 例，随访至初诊后 2 年（最终时间结点 2017 年 12 月）。回顾性分析患者病历资料并收集潜在危险因素，随访患者抗凝疗程及复查转归，计算复发率；根据是否复发分组，先进行单因素分析，再针对两组间有显著差异的危险因素进行多因素分析，最终得到与 APE 复发相关的独立危险预测因素。结果 169 例 APE 患者在接受 2 年随访后，共 23 例复发，复发概率为 13.6%。单因素分析：严重肺部疾病、长期卧床、恶性肿瘤、免疫系统疾病、特发性肺栓塞、D-二聚体持续异常 6 项因素在复发组与非复发组之间的差异有统计学意义（P<0.05），即与 APE 复发相关；多因素回归分析：恶性肿瘤（OR=8.384，P=0.003）、免疫系统疾病（OR=5.353，P=0.038）、特发性肺栓塞（OR=10.609，P=0.001）为 APE 患者复发的独立危险因素。结论 APE 患者有较高的栓塞复发率，恶性肿瘤、免疫系统疾病以及特发性肺栓塞是导致 APE 复发的独立危险因素。临床医师需要对此类患者进行定期的风险/获益评估后制定个体化的抗凝治疗方案。早期识别 APE 复发的独立危险因素对制定个体化的抗凝方案、改善患者的预后具有重要的临床指导意义。

Citation： 张鑫, 董丽霞, 曹洁, 韩雪娇. 急性肺栓塞患者复发的危险因素分析. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(5): 514-517. doi: 10.7507/1671-6205.201801054 Copy

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7.	Heit JA, Silverstein MD, Mohr DN, et al. Risk factors for deep vein thrombosis and pulmonary embolism-A population-based case-control study. Arch Intern Med, 2000, 160(6): 809-815.
8.	Hansson PO, Sörbo J, Eriksson H. Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. Arch Intern Med, 2000, 160(6): 769-774.
9.	Hutten BA, Prins MH, Gent M, et al. Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio: a retrospective analysis. J Clin Oncol, 2000, 18(17): 3078-3083.
10.	Duan Q, Gong Z, Song H, et al. Symptomatic venous thromboembolism is a disease related to infection and immune dysfunction. Int J Med Sci, 2012, 9(6): 453-461.
11.	宋浩明, 龚朱, 王乐民, 等. 静脉血栓栓塞症患者外周血单个核细胞 T 细胞免疫功能相关基因 mRNA 表达. 中华内科杂志, 2012, 51(7): 551-553.
12.	Zoller B, Li X, Sundquist J, et al. Autoimmune diseases and venous thromboembolism: a review of the literature. Am J Cardiovasc Dis, 2012, 2(3): 171-183.
13.	Yusuf HR, Hooper WC, Grosse SD, et al. Risk of venous thromboembolism occurrence among adults with selected autoimmune diseases: a study among a U.S. cohort of commercial insurance enrollees. Thromb Res, 2015, 135(1): 50-57.
14.	Kabrhel C, Varraso R, Goldhaber SZ, et al. Physical inactivity and idiopathic pulmonary embolism in women: prospective study. BMJ, 2011, 343: d3867.
15.	Burtscher M. Time spent sitting and idiopathic pulmonary embolism in women. Clin J Sport Med, 2012, 22(2): 167-168.
16.	Timp JF, Braekkan SK, Versteeg HH, et al. Epidemiology of cancer-associated venous thrombosis. Blood, 2013, 122(10): 1712-1723.
17.	Grau E, Real E, Medrano J, et al. Recurrent venous thromboembolism in a Spanish population: incidence, risk factors, and management in a hospital setting. Thromb Res, 1999, 96(5): 335-341.
18.	Schafer AI, Levine MN, Konkle BA, et al. Thrombotic disorders: diagnosis and treatment. Hematol Am Soc Hematol Educ Program, 2003: 520-539.
19.	Tosetto A, Iorio A, Marcucci M, et al. Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH). J Thromb Haemost, 2012, 10(6): 1019-1025.

1. 中华医学会心血管病学分会肺血管病学组. 急性肺栓塞诊断与治疗中国专家共识(2015). 中华心血管病杂志, 2016, 3(44): 197-211.
2. Tapson VF. Acute pulmonary embolism. N Engl J Med, 2008, 358(10): 1037-1052.
3. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35(43): 3033-3069k.
4. Shapiro NL, Bhatt SH. Critical Review and Update on the Treatment of Acute and Chronic Pulmonary Embolism. J Pharm Pract, 2016, 29(1): 35-45.
5. Heit JA, Mohr DN, Silverstein MD, et al. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med, 2000, 160(6): 761-768.
6. Eichinger S. Cancer associated thrombosis: risk factors and outcomes. Thromb Res, 2016, 140: S12-17.
7. Heit JA, Silverstein MD, Mohr DN, et al. Risk factors for deep vein thrombosis and pulmonary embolism-A population-based case-control study. Arch Intern Med, 2000, 160(6): 809-815.
8. Hansson PO, Sörbo J, Eriksson H. Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. Arch Intern Med, 2000, 160(6): 769-774.
9. Hutten BA, Prins MH, Gent M, et al. Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio: a retrospective analysis. J Clin Oncol, 2000, 18(17): 3078-3083.
10. Duan Q, Gong Z, Song H, et al. Symptomatic venous thromboembolism is a disease related to infection and immune dysfunction. Int J Med Sci, 2012, 9(6): 453-461.
11. 宋浩明, 龚朱, 王乐民, 等. 静脉血栓栓塞症患者外周血单个核细胞 T 细胞免疫功能相关基因 mRNA 表达. 中华内科杂志, 2012, 51(7): 551-553.
12. Zoller B, Li X, Sundquist J, et al. Autoimmune diseases and venous thromboembolism: a review of the literature. Am J Cardiovasc Dis, 2012, 2(3): 171-183.
13. Yusuf HR, Hooper WC, Grosse SD, et al. Risk of venous thromboembolism occurrence among adults with selected autoimmune diseases: a study among a U.S. cohort of commercial insurance enrollees. Thromb Res, 2015, 135(1): 50-57.
14. Kabrhel C, Varraso R, Goldhaber SZ, et al. Physical inactivity and idiopathic pulmonary embolism in women: prospective study. BMJ, 2011, 343: d3867.
15. Burtscher M. Time spent sitting and idiopathic pulmonary embolism in women. Clin J Sport Med, 2012, 22(2): 167-168.
16. Timp JF, Braekkan SK, Versteeg HH, et al. Epidemiology of cancer-associated venous thrombosis. Blood, 2013, 122(10): 1712-1723.
17. Grau E, Real E, Medrano J, et al. Recurrent venous thromboembolism in a Spanish population: incidence, risk factors, and management in a hospital setting. Thromb Res, 1999, 96(5): 335-341.
18. Schafer AI, Levine MN, Konkle BA, et al. Thrombotic disorders: diagnosis and treatment. Hematol Am Soc Hematol Educ Program, 2003: 520-539.
19. Tosetto A, Iorio A, Marcucci M, et al. Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH). J Thromb Haemost, 2012, 10(6): 1019-1025.

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Chinese Journal of Respiratory and Critical Care Medicine

急性肺栓塞患者复发的危险因素分析

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