急性肺栓塞后慢性血栓栓塞性肺动脉高压研究进展

Research progress in the chronic thromboembolic pulmonary hypertension after acute pulmonary embolism

慢性血栓栓塞性肺动脉高压(CTEPH),被世界卫生组织(WHO)列为肺动脉高压分型的第四大类,是目前唯一可能治愈的肺动脉高压。不干预则远期预后不佳。本综述从CTEPH的危险因素、临床表现、治疗策略及急性肺栓塞(PE)后的随访等几方面进行分析,目的是提高对CTEPH的认识并早期干预。应用中国知网和PubMed中英文数据库,以"慢性血栓栓塞性肺动脉高压""急性肺栓塞""危险因素"和"诊断"为关键词,检索2015-01-01-2021-01-10相关文献。纳入标准:(1)慢性血栓栓塞性肺动脉高压危险因素;(2)慢性血栓栓塞性肺动脉高压诊断;(3)急性肺栓塞后慢性血栓栓塞性肺动脉高压的诊断。排除标准:(1)年份较远的综述类文献;(2)质量较差的文献。最终42篇文献纳入分析。结果表明,CTEPH是急性PE最严重的远期并发症,其起病隐匿,医患对疾病认识不足,PE后综合征的患病率高,缺乏明确的指南建议,以及在临床实践中诊断测试的效率低下等因素,导致诊断延迟时间>1年,增加死亡风险,故早期明确诊断和积极治疗至关重要。对于疑似CTEPH的诊断患者,应从超声心动图检查开始。肺通气/灌注(V/Q)显像通常作为CTEPH诊断的首选筛查方式,确诊仍需依据右心导管(RHC)和肺动脉造影(PAG)检查。而对急性PE后患者随访观察有助于早期发现CTEPH。

Chronic thromboembolic pulmonary hypertension(CTEPH),classified as the fourth pulmonary hypertension(PH)by World Health Organization(WHO),is the only PH that may be cured at present.Without intervention,the long-term prognosis of CTEPH is poor.In this review,we will focus on the risk factors,clinical manifestations,as well as the diagnosis of CTEPH after acute PE,so as to facilitate early identification of CTEPH and intervention.Using China National Knowledge Infrastructure and PubMed Chinese and English databases,with"chronic thromboembolic pulmonary hypertension","acute pulmonary embolism","risk factors"and"diagnosis"as keywords,searched the relevant literatures from January 1,2015 to January 10,2021.Inclusion criteria:(1)risk factors of chronic thromboembolic pulmonary hypertension.(2)Diagnosis of chronic thromboembolic pulmonary hypertension.(3)Diagnosis of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism.Removal criteria:(1)review literature that were far away in years.(2)literature with Poor quality literature and disordered word order.Finally,42 articles were included in the analysis.The result show that CTEPH is the most severe long-term complication of acute pulmonary embolism,poor awareness of the disease by patients and physicians,high prevalence of the post-PE syndrome,lack of clear recommendations as well as inefficient application of diagnostic tests in clinical practice,lead to a reported staggering diagnostic delay of longer than 1 year.Therefore,it is very important to make a timely diagnosis and treatment.For suspected patients with CTEPH,starting with echocardiography.V/Q ECT is usually used as the first screening method for the diagnosis of CTEPH,but the definite diagnosis still needs to be based on right heart catheterization(RHC)and pulmonary angiography(PAG).In addition,follow-up observation on patients with acute PE is helpful for early detection of CTEPH.