老年与中青年急性肺血栓栓塞症(PTE)患者的临床特征分析

 目的 比较老年与中青年急性肺血栓栓塞症(pulmonary thromboembolism,PTE)患者的临床特点,提高诊断水平。方法 回顾性分析2009年11月至2011年4月在复旦大学附属中山医院呼吸科住院诊治的57例经螺旋CT肺动脉造影(CT pulmonary angiography,CTPA)确诊为PTE患者的临床资料。按患者年龄分为中青年组(<60岁)22例和老年组(≥60岁)35例,对两组的一般资料、肺血栓栓塞症的危险因素、临床症状、实验室及影像学检查等资料进行统计学分析。结果 老年组中16例(45.7%)既往有高血压病史,老年组高血压的发生率显著高于中青年组(9.1%,P<0.01);呼吸困难是PTE最常见的临床症状;老年组晕厥发生率高(P<0.05),而胸痛发生率低(P<0.05)。老年组更易发生肺动脉高压(P<0.05)。血清肌钙蛋白T(cardiac troponin T,cTnT)≥0.01 ng/mL者,老年组发生率 (48.0%)高于中青年组(12.5%)(P<0.05)。 结论 老年人急性PTE症状不典型,容易漏诊和误诊,且更容易合并肺动脉高压和右心功能不全,病情更重,预后不良,需足够重视。

Acute pulmonary thromboembolism (PTE) : comparison of presentation between young and middle-aged and elder patients

Objective To compare the clinical feature of young and middle aged and elder patients with acute pulmonary thromboembolism (PTE),in order to improve the diagnosis of the disease. Methods The clinical data were reviewed for 57 patients with acute PTE diagnosed through CT pulmonary angiography (CTPA) from Nov. 2009 to Apr. 2011 in Zhongshan Hospital,Fudan University.The general data,risk factors,clinical symptoms,laboratory and imaging data of acute PTE in 22 young and middle aged patients (<60 years) and 35 elder patients (≥60 years) were statistically analyzed.Results Sixteen cases (45.7%) experienced primary hypertension in elderly group, which is significantly more than the 2 cases (9.1%) in young and middle aged group (P<0.01).Dyspnea was the most frequent symptom both in elderly and young and middle aged patients.In elder patients,20% had one or more episodes of syncope, while none of young and middle aged patients had such an episode (P<0.05).Chest pain was the primary presenting complaint in 59.1% of young and middle aged patients, but only in 31.4% of elder patients (P<0.05).Elder patients would be at risk of developing pulmonary hypertension more than young and middle aged patients (P<0.05).In elder patients,48% showed more incidence of higher values of cardiac troponin T (cTnT) (≥0.01 ng/mL),compared with 12.5% of young and middle aged patients (P<0.05). Conclusions The elder patients represent atypically with acute PTE,potentially leading to missed diagnosis and misdiagnosis.Elderly with PTE are more often accompanied by pulmonary hypertension and right ventricular dysfunction than the young.For their unfavourable prognosis,more attention should be paid to elder patients.