肺栓塞在COPD 急性加重期中的作用_Chinese Journal of Respiratory and Critical Care Medicine

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董昭兴 , 张涛 , 李永霞

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Keywords：

肺栓塞; COPD; 急性加重

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COPD 在世界范围均是主要的健康负担, 到2020 年,COPD 将可能成为第三大的死亡原因。而大部分COPD 死亡发生在它的急性发作期。以前的研究表明50% ～70% 的
COPD 急性加重( AECOPD) 是由于感染造成, 10% 归于环境因素, 超过30% 的患者发作原因并不清楚[ 1] 。其主要发作的症状是咳嗽和呼吸困难, 而肺栓塞( PE) 的症状很难从中
区分。有报道认为COPD 发生PE 和其他静脉血栓形成的概率是非COPD 患者的2 倍, 同时也认为COPD 是发生PE 的主要危险因素, PE 可能是COPD 急性发作常见原因[ 2] 。而
目前的COPD 诊治指南并未明确PE 是COPD 急性发作的可能原因之一, 只是在治疗中提出对卧床、红细胞增多症或脱水的患者, 无论是否有血栓栓塞性疾病史均需考虑使用肝素
或低分子肝素。这种观点可能是从PE 的危险评估角度来看, 但也可能造成临床使用时抗凝剂量的不充分, 导致COPD 患者死亡。那么PE 在AECOPD 中的地位究竟如何?现就相关研究文献综述如下。

Citation： 董昭兴,张涛,李永霞. 肺栓塞在COPD 急性加重期中的作用. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(6): 652-653. doi: Copy

1.	Sapey E, Stockley RA. COPD exacerbations: 2. Aetiology. Thorax,2006, 61: 250-258 .
2.	Sidney S, Sorel M, Quesenberry CP Jr, et al. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest, 2005 , 128: 2068-2075.
3.	Carson JL, Terrin ML, Duff A, et al. Pulmonary embolism and mortality in patients with COPD. Chest, 1996, 110: 1212-1219.
4.	Tillie-Leblond I,Marquette CH, Perez T, et al. Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors. Ann Intern Med,2006, 144: 390-396.
5.	Erelel M, Cuhadaroglu C, Ece T, et al. The frequency of deep venous thrombosis and pulmonary embolus in acute exacerbation of chronic obstructive pulmonary disease. Respir Med, 2002 , 96: 515 -518.
6.	Shetty R, Seddighzadeh A, Piazza G, et al. Chronic obstructive pulmonary disease and deep vein thrombosis: a prevalent combination. J Thromb Thrombolysis, 2008, 26 : 35-40.
7.	Rutschmann OT, Cornuz J, Poletti PA, et al. Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease? Thorax, 2007, 62 : 121-125 .
8.	Rizkallah J, Man SF, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and meta analysis. Chest, 2009, 135: 786 -793.
9.	Lippmann M, Fein A. Pulmonary embolism in the patient with chronic obstructive pulmonary disease. A diagnostic dilemma.Chest, 1981, 79: 39-42.
10.	Wagner PD, Dantzker DR, Dueck R, et al. Ventilationperfusion inequality in chronic obstructive pulmonary disease. J Clin Invest,1977, 59: 203-216 .
11.	Hartmann IJ, Hagen PJ, Melissant CF, et al. Diagnosing acute pulmonary embolism: effect of chronic obstructive pulmonary disease on the performance of D-dimer testing, ventilation/ perfusion scintigraphy, spiral computed tomographic angiography, and conventional angiography. ANTELOPE Study Group. Advances in New Technologies Evaluating the Localization of Pulmonary Embolism. Am J Respir Crit Care Med, 2000, 162 : 2232-2237.
12.	Ambrosetti M, Ageno W, Spanevello A, et al. Prevalence and prevention of venous thromboembolism in patients with acute exacerbations of COPD. Thromb Res, 2003 , 112: 203-207.
13.	Fraisse F, Holzapfel L, Couland JM, et al. Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD.The association of non-university affiliated intensive care specialist physicians of france. Am J Respir Crit Care Med, 2000, 161: 1109 -1114.
14.	Kahn SR, Panju A, GeertsW, et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res, 2007, 119 : 145-155.
15.	Alikhan R, Cohen AT. A safety analysis of thromboprophylaxis in acute medical illness. Thromb Haemost, 2003 , 89: 590-591.
16.	Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: american college of chest physicians evidencebased clinical practice guidelines ( 8th Edition) . Chest, 2008, 133 :381S-453S.

1. Sapey E, Stockley RA. COPD exacerbations: 2. Aetiology. Thorax,2006, 61: 250-258 .
2. Sidney S, Sorel M, Quesenberry CP Jr, et al. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest, 2005 , 128: 2068-2075.
3. Carson JL, Terrin ML, Duff A, et al. Pulmonary embolism and mortality in patients with COPD. Chest, 1996, 110: 1212-1219.
4. Tillie-Leblond I,Marquette CH, Perez T, et al. Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors. Ann Intern Med,2006, 144: 390-396.
5. Erelel M, Cuhadaroglu C, Ece T, et al. The frequency of deep venous thrombosis and pulmonary embolus in acute exacerbation of chronic obstructive pulmonary disease. Respir Med, 2002 , 96: 515 -518.
6. Shetty R, Seddighzadeh A, Piazza G, et al. Chronic obstructive pulmonary disease and deep vein thrombosis: a prevalent combination. J Thromb Thrombolysis, 2008, 26 : 35-40.
7. Rutschmann OT, Cornuz J, Poletti PA, et al. Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease? Thorax, 2007, 62 : 121-125 .
8. Rizkallah J, Man SF, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and meta analysis. Chest, 2009, 135: 786 -793.
9. Lippmann M, Fein A. Pulmonary embolism in the patient with chronic obstructive pulmonary disease. A diagnostic dilemma.Chest, 1981, 79: 39-42.
10. Wagner PD, Dantzker DR, Dueck R, et al. Ventilationperfusion inequality in chronic obstructive pulmonary disease. J Clin Invest,1977, 59: 203-216 .
11. Hartmann IJ, Hagen PJ, Melissant CF, et al. Diagnosing acute pulmonary embolism: effect of chronic obstructive pulmonary disease on the performance of D-dimer testing, ventilation/ perfusion scintigraphy, spiral computed tomographic angiography, and conventional angiography. ANTELOPE Study Group. Advances in New Technologies Evaluating the Localization of Pulmonary Embolism. Am J Respir Crit Care Med, 2000, 162 : 2232-2237.
12. Ambrosetti M, Ageno W, Spanevello A, et al. Prevalence and prevention of venous thromboembolism in patients with acute exacerbations of COPD. Thromb Res, 2003 , 112: 203-207.
13. Fraisse F, Holzapfel L, Couland JM, et al. Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD.The association of non-university affiliated intensive care specialist physicians of france. Am J Respir Crit Care Med, 2000, 161: 1109 -1114.
14. Kahn SR, Panju A, GeertsW, et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res, 2007, 119 : 145-155.
15. Alikhan R, Cohen AT. A safety analysis of thromboprophylaxis in acute medical illness. Thromb Haemost, 2003 , 89: 590-591.
16. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: american college of chest physicians evidencebased clinical practice guidelines ( 8th Edition) . Chest, 2008, 133 :381S-453S.

Chinese Journal of Respiratory and Critical Care Medicine

肺栓塞在COPD 急性加重期中的作用

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