不同年龄段患肺血栓栓塞症的危险因素及临床特征比较

Differences in clinical features and risk factors of pulmonary thromboembolism between older and younger patients

目的探讨不同年龄段肺血栓栓塞症(PTE)临床特征的差异,提高对各年龄组人群PTE的认识。方法对广州医学院第一附属医院广州呼吸疾病研究所1997年8月至2006年4月确诊为急性PTE的105例患者(其中年龄≥60岁组57例,<60岁组48例)的临床资料进行回顾性分析,比较两年龄段PTE的危险因素及临床特征的差异。结果(1)危险因素:<60岁组PTE的发病危险因素较≥60岁组少。静脉炎在两组均是最常见的危险因素。<60岁组PTE患者常见的危险因素还包括静脉注射毒品、家族性易栓症等;而慢性阻塞性肺疾病(COPD)、长期制动、恶性肿瘤、心脏病等危险因素更常见于≥60岁组的PTE患者。(2)临床症状:胸痛和咯血在<60岁组中相对多见,三联征(即同时具有呼吸困难、胸痛和咯血症状)更常见于<60岁组;而晕厥则常发生于≥60岁组的PTE患者。≥60岁组更易发生大面积PTE。(3)实验室改变:<60岁组动脉血氧分压(PaO2)平均绝对值高于≥60岁组,PaO2相对百分比在两组间差异无显著性意义。两组肌钙蛋白阴性的PTE患者出现严重并发症几率明显低于肌钙蛋白阳性者。结论≥60岁的PTE患者危险因素多,临床表现可能不典型,且更易出现大面积PTE;<60岁的PTE患者临床症状可相对典型。心肌肌钙蛋白可作为PTE预后的评估指标。

Objective In order to improve diagnosis of pulmonary thromboembolism（ PTE）, the clinical features of pulmonary embolism between older and younger patients were compared. Methods Totally 105 patients （57 older and 48 younger） with diagnosed PTE were assessed retrospectively. Results There were more risk factors in the elderly as compared with younger group. Phlebitis was the major risk factor in both groups. Other risk factors, such as COPD,immobilization, malignancy and cardiac disease, were more frequent in the elderly;whereas in younger patients, intravenous drug injection and genetic factors were more frequent. Chest pain and hemoptysis were less frequent in older patients whereas syncope occurred more often in the older group. ＂Triplicate symptoms＂ （including dyspnea, chest pain and hemoptysis）occurred more often in the younger group. Massive PTE occurred more often in the older patients. Severe complications were more frequent in cTnT-positive patients. Conclusion There are more risk factors in the elderly. The clinical presentation of PTE is often atypical in elderly patients,and prone to develop massive PTE. cTnT（ Cardiac troponin T）is an independent predictor of prognostic implications in patients with confirmed PTE.