80岁及以上老年女性肺血栓栓塞症患者的临床特点分析
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摘要
目的探讨女性与男性高龄肺血栓栓塞症(PTE)患者的危险因素、辅助检查及病情严重性的差异。方法回顾性分析我院住院的高龄PTE患者119例,女性72例,男性47例,比较女性与男性临床症状、既往病史、实验室检查、影像学检查、治疗方案及危险分层的差异。进行危险分层综合评估、危险分层评分[包括肺栓塞严重程度指数(PESI)和简化版PESI(sPESI)]及预后评分。结果与男性比较,女性吸烟、血红蛋白、肌酐及心房颤动比例明显降低,既往PTE、淋巴细胞、心电图V2、V3导联T波改变及口服抗凝药物比例明显升高(P<0.05,P<0.01)。女性PESI评分明显低于男性[86.5(82.0,101.8)分vs 102.0(94.0,112.0)分,P<0.01]。女性与男性临床症状、sPESI、预后评分及危险分层综合评估比较,无统计学差异(P>0.05)。结论高龄女性与男性PTE患者相比,心电图胸前V2、V3导联T波改变多见,高龄PTE患者临床症状、各类预后评分分值及危险分层无性别差异。
Objective To study the risk factors,auxiliary examinations and severity of disease between elderly female and male pulmonary thromboem bolism(PTE)patients.Methods One hundred and nineteen elderly PTE patients(72 females and 47 males)admitted to our hospital were included in this study.Their clinical symptoms,past medical history,laboratory testing parameters,imaging data,treatment plan,and risk stratification were compaired between elderly female and male PTE patients.The risk stratification such as PESI,sPESI,and prognosis scores were assessed.Results The rate of past PTE history was significantly higher while that of smoking was significantly lower in female patients than in male patients(P<0.05,P<0.01).The serum hemoglobin and creatinine levels and the incidence of AF were significantly lower while the number of lymphocytes was significantly greater,the change of V2 and V3 lead T-waves was more obvious and the ratio of oral anticoagulation therapy was significantly higher in female patients than in male patients(P<0.05,P<0.01).The PESI score was significantly lower in female patients than in male patients(86.5 vs 102.0,P<0.01).No significant difference was detected in clinical symptoms,sPESI score,prognosis score and risk stratification between female and male PTE patients(P>0.05).Conclusion No significant difference is detected in clinical symptoms,sPESI score,prognosis score and risk stratification between elderly male and female PTE patients.Changes of V2 and V3 lead T-waves on ECG are common in female PTE patients.
Objective To study the risk factors,auxiliary examinations and severity of disease between elderly female and male pulmonary thromboem bolism(PTE)patients.Methods One hundred and nineteen elderly PTE patients(72 females and 47 males)admitted to our hospital were included in this study.Their clinical symptoms,past medical history,laboratory testing parameters,imaging data,treatment plan,and risk stratification were compaired between elderly female and male PTE patients.The risk stratification such as PESI,sPESI,and prognosis scores were assessed.Results The rate of past PTE history was significantly higher while that of smoking was significantly lower in female patients than in male patients(P<0.05,P<0.01).The serum hemoglobin and creatinine levels and the incidence of AF were significantly lower while the number of lymphocytes was significantly greater,the change of V2 and V3 lead T-waves was more obvious and the ratio of oral anticoagulation therapy was significantly higher in female patients than in male patients(P<0.05,P<0.01).The PESI score was significantly lower in female patients than in male patients(86.5 vs 102.0,P<0.01).No significant difference was detected in clinical symptoms,sPESI score,prognosis score and risk stratification between female and male PTE patients(P>0.05).Conclusion No significant difference is detected in clinical symptoms,sPESI score,prognosis score and risk stratification between elderly male and female PTE patients.Changes of V2 and V3 lead T-waves on ECG are common in female PTE patients.
引文
[1]Wang H,Ye J,Wang L,et al.Risk characteristics of venous thromboembolism in Chinese patients[J].Clin Appl Thromb Hemost,2016,22(5):490-494.DOI:10.1177/1076029615569272.
[2]中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组.肺血栓栓塞症诊治与预防指南[J].中华医学杂志,2018,98(14):1060-1087.DOI:10.3760/cma.j.issn.0376-2491.2018.14.007.
[3]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)[J].中华心血管病杂志,2016,44(3):197-211.DOI:10.3760/cma.j.issn.0253-3758.2016.03.005.
[4]Hobohm L,Hellenkamp K,HasenfuβG,et al.Comparison of risk assessment strategies for not-high-risk pulmonary embolism[J].Eur Respir J,2016,47(4):1170-1178.DOI:10.1183/13993003.01605-2015.
[5]Elias A,Mallett S,Daoud-Elias M,et al.Prognostic models in acute pulmonary embolism:a systematic review and metaanalysis[J].BMJ Open,2016,6(4):e010324.DOI:10.1136/bmjopen-2015-010324.
[6]Aminian A,Andalib A,Khorgami Z,et al.Who should get extended thromboprophylaxis after bariatric surgery?:a risk assessment tool to guide indications for post-discharge pharmacoprophylaxis[J].Ann Surg,2017,265(1):143-150.DOI:10.1097/SLA.0000000000001686.
[7]Agarwal S,Clark D 3rd,Sud K,et al.Gender disparities in outcomes and resource utilization for acute pulmonary embolism hospitalizations in the United States[J].Am J Cardiol,2015,116(8):1270-1276.DOI:10.1016/j.amjcard.2015.07.048.
[8]Barrios D,Morillo R,Guerassimova I,et al.Sex differences in the characteristics and short-term prognosis of patients presenting with acute symptomatic pulmonary embolism[J].PLoS One,2017,12(11):e0187648.DOI:10.1371/journal.pone.0187648.
[9]Roach RE,Cannegieter SC,Lijfering WM.Differential risks in men and women for first and recurrent venous thrombosis:the role of genes and environment[J].J Thromb Haemost,2014,12(10):1593-1600.DOI:10.1111/jth.12678.
[10]刘运秋,杨晓燕,王丽晔,等.血清高敏C反应蛋白水平对肺栓塞预测价值的研究[J].中国循环杂志,2015,30(9):854-858.DOI:10.3969/j.issn.1000-3614.2015.09.08.
[11]侯银静,秦明照,刘谦,等.不同性别急性肺栓塞患者临床特点分析[J].中国综合临床,2016,32(7):611-614.DOI:10.3760/cma.j.issn.1008-6315.2016.07.010.
[12]Telo S,Kulu9ztürk M,Deveci F,et al.The relationship between platelet-to-lymphocyte ratio and pulmonary embolism severity in acute pulmonary embolism[J].Int Angiol,2019,38(1):4-9.DOI:10.23736/S0392-9590.18.04028-2.
[13]吕静,魏庆民,王志华,等.不同血红蛋白水平对急性肺栓塞右心功能的影响[J].中国老年学杂志,2018,38(1):85-86.DOI:10.3969/j.issn.1005-9202.2018.01.033.
[14]Ackerly I,Klim S,McFarlane J,et al.Diagnostic utility of an age-specific cut-off for D-dimer for pulmonary embolism assessment when used with various pulmonary embolism risk scores[J].Intern Med J,2018,48(4):465-468.DOI:10.1111/imj.13753.
[15]Van Gent JM,Calvo RY,Zander AL,et al.Risk factors for deep vein thrombosis and pulmonary embolism after traumatic injury:a competing risks analysis[J].J Trauma Acute Care Surg,2017,83(6):1154-1160.DOI:10.1097/TA.0000000000001652.
[16]侯银静,秦明照,陈一文.简化肺栓塞严重程度指数在老年非高危肺血栓栓塞症患者中的应用[J].中华老年心脑血管病杂志,2016,18(12):1243-1246.DOI:10.3969/j.issn.1009-0126.2016.12.004.
[2]中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组.肺血栓栓塞症诊治与预防指南[J].中华医学杂志,2018,98(14):1060-1087.DOI:10.3760/cma.j.issn.0376-2491.2018.14.007.
[3]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)[J].中华心血管病杂志,2016,44(3):197-211.DOI:10.3760/cma.j.issn.0253-3758.2016.03.005.
[4]Hobohm L,Hellenkamp K,HasenfuβG,et al.Comparison of risk assessment strategies for not-high-risk pulmonary embolism[J].Eur Respir J,2016,47(4):1170-1178.DOI:10.1183/13993003.01605-2015.
[5]Elias A,Mallett S,Daoud-Elias M,et al.Prognostic models in acute pulmonary embolism:a systematic review and metaanalysis[J].BMJ Open,2016,6(4):e010324.DOI:10.1136/bmjopen-2015-010324.
[6]Aminian A,Andalib A,Khorgami Z,et al.Who should get extended thromboprophylaxis after bariatric surgery?:a risk assessment tool to guide indications for post-discharge pharmacoprophylaxis[J].Ann Surg,2017,265(1):143-150.DOI:10.1097/SLA.0000000000001686.
[7]Agarwal S,Clark D 3rd,Sud K,et al.Gender disparities in outcomes and resource utilization for acute pulmonary embolism hospitalizations in the United States[J].Am J Cardiol,2015,116(8):1270-1276.DOI:10.1016/j.amjcard.2015.07.048.
[8]Barrios D,Morillo R,Guerassimova I,et al.Sex differences in the characteristics and short-term prognosis of patients presenting with acute symptomatic pulmonary embolism[J].PLoS One,2017,12(11):e0187648.DOI:10.1371/journal.pone.0187648.
[9]Roach RE,Cannegieter SC,Lijfering WM.Differential risks in men and women for first and recurrent venous thrombosis:the role of genes and environment[J].J Thromb Haemost,2014,12(10):1593-1600.DOI:10.1111/jth.12678.
[10]刘运秋,杨晓燕,王丽晔,等.血清高敏C反应蛋白水平对肺栓塞预测价值的研究[J].中国循环杂志,2015,30(9):854-858.DOI:10.3969/j.issn.1000-3614.2015.09.08.
[11]侯银静,秦明照,刘谦,等.不同性别急性肺栓塞患者临床特点分析[J].中国综合临床,2016,32(7):611-614.DOI:10.3760/cma.j.issn.1008-6315.2016.07.010.
[12]Telo S,Kulu9ztürk M,Deveci F,et al.The relationship between platelet-to-lymphocyte ratio and pulmonary embolism severity in acute pulmonary embolism[J].Int Angiol,2019,38(1):4-9.DOI:10.23736/S0392-9590.18.04028-2.
[13]吕静,魏庆民,王志华,等.不同血红蛋白水平对急性肺栓塞右心功能的影响[J].中国老年学杂志,2018,38(1):85-86.DOI:10.3969/j.issn.1005-9202.2018.01.033.
[14]Ackerly I,Klim S,McFarlane J,et al.Diagnostic utility of an age-specific cut-off for D-dimer for pulmonary embolism assessment when used with various pulmonary embolism risk scores[J].Intern Med J,2018,48(4):465-468.DOI:10.1111/imj.13753.
[15]Van Gent JM,Calvo RY,Zander AL,et al.Risk factors for deep vein thrombosis and pulmonary embolism after traumatic injury:a competing risks analysis[J].J Trauma Acute Care Surg,2017,83(6):1154-1160.DOI:10.1097/TA.0000000000001652.
[16]侯银静,秦明照,陈一文.简化肺栓塞严重程度指数在老年非高危肺血栓栓塞症患者中的应用[J].中华老年心脑血管病杂志,2016,18(12):1243-1246.DOI:10.3969/j.issn.1009-0126.2016.12.004.