老年急性肺血栓栓塞症患者出血事件发生情况及影响因素  

Analysis of clinical relevant bleeding events in the elderly patients with acute pulmonary thromboembolism after treatment

作　　者：龚娟妮[1] 翟振国[2] 杨媛华[1] 张竹[3] 谢万木[2] 邝土光[1] 王辰[2] 

机构地区：[1]北京呼吸疾病研究所北京市呼吸与肺循环疾病重点实验室首都医科大学附属北京朝阳医院呼吸与危重症医学科,100020 [2]中日友好医院国家呼吸疾病临床医学研究中心北京呼吸疾病研究所 [3]首都医科大学附属北京安贞医院

出　　处：《中华医学杂志》2015年第44期3588-3592,共5页National Medical Journal of China

基　　金：国家科技支撑计划（2011BAI11B17）;首都卫生发展科研专项基金（首发2011-1004-03）;卫生行业科研专项基金（201302008）;北京市自然科学基金（7152062）

摘　　要：目的分析老年急性肺血栓栓塞症（PTE）患者出血事件的发生情况及影响因素。方法前瞻性纳入2009年1月至2013年12月北京朝阳医院初次诊断的年龄≥14岁急性胛E患者共539例，全面采集人选患者的病史、症状、体征、影像学、实验室检查、治疗情况、治疗转归（含病死率、复发率和出血发生率），规律随访3个月，并根据年龄分为非老年组（≤65岁）及老年组（〉65岁），比较两组出血事件的发生情况。结果老年组3个月出血累积发生率及临床相关性非大出血累积发生率显著高于非老年组（20．2％比13．4％，P=0．038及16．7％比10．5％，P=0．043），胃肠道出血的累积发生率显著高于非老年组（6．0％比1．4％，P=0．005），且主要集中在初始治疗1个月内。慢性肝病（P=0．001，OR=9．229）、缺血性脑卒中（P=0．001，OR=6．323）和贫血（P=0．014，OR=3．774）是老年患者大出血的独立危险因素；恶性肿瘤是临床相关性非大出血的独立危险因素（P〈0．001，OR=3．140）；糖尿病（P=0．012，OR=3．711）和贫血（P〈0．001，OR=5．863）是胃肠道出血的独立危险因素。结论老年急性PTE患者总出血累积发生率、临床相关性非大出血发生率高，胃肠道出血发生率高，且主要集中在初始治疗的1个月内，合并疾病的存在可以增加老年PTE患者的出血风险。Objective To investigate the incidences of clinical relevant bleeding events and risk factors in elderly patients with acute pulmonary thromboembolism （PTE）. Methods Between January of 2009 and December of 2013, a total of 539 initially diagnosed PTE patients were recruited in our study in Beijing Chao Yang hospital. Basic clinical characteristics, medical history, imaging results, laboratory tests, therapy and outcomes （ including mortality, recurrence and incidences of bleeding events） were collected during 3 months＇ follow-up. All the patients were divided into two groups according to age （ ≤ 65 years and 〉 65 years ）, and these parameters were compared between the two groups. Results Compared with younger patients （ ≤ 65 years old）, older patients （ 〉 65 years） had higher incidences of total bleeding, clinical relevant non-major bleeding （20.2% vs 13.4% , P =0. 038 ; 16.7% vs 10.5% , P =0. 043）. The incidence of gastrointestinal bleeding of the elderly was also higher than that of younger patients （6. 0% vs 1.4%, P = 0. 005 ） and majority of bleeding events were within 1 month after initial treatment. For the elderly, chronic liver diseases （ P = 0. 001, OR = 9. 229） , ischemic stroke （ P = 0. 001, OR = 6. 323） andanemia （P =0. 014, OR =3. 774） were independent risk factors for major bleeding, and malignancy （P 〈 0. 001, OR = 3. 140） was independent risk factor for clinical relevant non-major bleeding. The independent risk factors for gastrointestinal bleeding were diabetes mellitus （ P = 0. 012, OR = 3.711 ） and anemia （ P 〈 0. 001, OR = 5. 863 ）. Conclusions The older PTE patients had higher incidences of total bleeding and clinical relevant non-major bleeding. Gastrointestinal bleeding of the elderly was also higher than that of younger patients and mainly occurred within I month after initial treatment. Complications can increase the risk of bleeding in older PTE oatients.

关 键 词：老年人 肺栓塞 出血 因素分析 统计学 

分 类 号：R563.5[医药卫生—呼吸系统]