经抗凝治疗的非高危肺栓塞患者远期预后分析  

Long-term outcome of non-high-risk pulmonary embolism following anticoagulation

作　　者：许明玲[1] 程兆忠[2] 王丽君[2] 邵艳梅[2] 

机构地区：[1]青岛大学医学院,266000 [2]青岛大学附属医院崂山院区呼吸科,266000

出　　处：《国际呼吸杂志》2017年第4期276-280,共5页International Journal of Respiration

摘　　要：目的 对经抗凝治疗的中危、低危肺栓塞患者进行随访,分析其远期预后,探讨影响预后的危险因素.方法 回顾性收集青岛大学附属医院自2010年1月至2015年1月初次诊断的424例非高危肺栓塞患者住院及门诊随访资料,电话随访患者出院后华法林应用情况、监测情况及临床转归,探讨其远期预后（死亡、再发深静脉血栓、慢性血栓栓塞性肺动脉高压和/或右心衰竭、抗凝后引起出血）差别并分析导致不良预后的危险因素.结果 随访424例中、低危肺栓塞患者,为期1.0～5.5年,失访41例,死亡65例.不同危险分层非高危肺栓塞患者远期预后差异有统计学意义（H=-5.261,P〈0.05）;不同危险分层间死亡、慢性血栓栓塞性肺动脉高压、出血及再发深静脉血栓差异有统计学意义（P值均〈0.001）.多因素logistic回归分析显示年龄（OR=1.029,95%CI：1.008～1.049）、恶性肿瘤（OR=6.300,95%CI：2.906～13.658）、右心功能不全（OR=4.058,95%CI：2.482～6.635）、隐源性肿瘤（OR=22.667,95%CI：2.298～223.537）为影响长期预后的危险因素.结论 非高危肺栓塞患者预后存在差异.高龄、恶性肿瘤、右心功能不全及隐源性肿瘤可能是影响非高危肺栓塞患者不良预后的主要危险因素.Objective To evaluate the long-term outcome and the related factors of sub-massive pulmonary embolism after anticoagulation.Methods Clinical data and the clinic follow-up data of 424 cases diagnosed as non-high-risk pulmonary embolism from January 2010 to January 2015 in the Affiliated Hospital of Qingdao University were collected.Telephone follow-up was made to investigate the warfarin medication,monitoring status and clinical outcomes.Close attention was paid to clinical data,risk stratification and the clinical events,including death,recurrent thromboembolic events,chronic thromboembolic pulmonary hypertension,bleeding complications attributed to anticoagulant therapy. Single and multiple factor logistic regression analysis were performed to explore the risk factors that might affect the long-term prognosis.Results 424 patients were retrospectively reviewed and followed up for 1.0-5.5 years with 41 dropping out and 65 deaths.The result showed that intermediate-high risk, intermediate-low risk and low risk pulmonary embolism had a different long-term outcome （H =-5.261,P 〈0.05）.There were significant differences in death,chronic thromboembolic pulmonary hypertension,bleeding and recurrent thromboembolic among different risk stratifications（all P〈0.001）. Multivariate logistic regression analysis revealed that age （OR = 1.029,95% CI ：1.008-1.049）, malignant tumor（OR =6.300,95% CI ：2.906-13.658）,right ventricular dysfunction （OR =4.058, 95%CI ：2.482-6.635） and occult cancer （OR =22.667,95% CI ：2.298-223.537） were risk factors affecting the long-term prognosis.Conclusions The long-term outcome differs among different risk stratifications of non-high-risk pulmonary embolism.Age,malignant tumor,right ventricular dysfunction and occult cancer may be the risk factors affecting the long-term prognosis in patients with non-high-risk pulmonary embolism.

关 键 词：非高危肺栓塞 抗凝 远期预后 危险因素 

分 类 号：R563.5[医药卫生—呼吸系统]