肺血栓栓塞症预后因素分析

目前,随着认识的增加、诊断技术的提高,肺血栓栓塞症(PTE)的发病率明显呈上升趋势。同时,大家对PTE预后的关注也越来越多,其预后差异较大,轻者可无明显症状,但治愈后有可能复发,严重者可发展成慢性血栓栓塞性肺动脉高压(CTEPH),甚至死亡,且病死率较高。因此,及时识别PTE的预后危险因素对改善患者预后具有重要意义。本文通过PubMed、CNKI等检索相关文献,就影响PTE预后的因素作一综述。影响PTE预后的因素多种多样:PTE预后与肺栓塞严重指数(PESI)评分系统、疾病危险分层、治疗方案选择及治疗并发症等因素密切相关,亦与血清标志物如BNP/NT-proBNP、肌钙蛋白和D-二聚体存在必然的联系;PESI评分系统是评估PTE预后最广泛有效的指标,其中高龄患者和合并恶性肿瘤患者预后不良事件发生率大大增加,可能是影响PTE预后的两大独立危险因素。对于临床上那些存在危险预后因素的PTE患者,应高度警惕,采取个体化治疗,加强对患者的规范化管理,从而改善预后,提高生存率。 

Analysis of prognostic factors of pulmonary thromboembolism

With the increase of knowledge and the improvement of diagnostic techniques nowadays,the morbidity of pulmonary thromboembolism (PTE) is obviously on the rise.Moreover,a growing number of people are concerned about PTE prognosis,which shows great differences.It can be asymptomatic in less severe cases,but it may be recurrent after cure.In severe cases,it can develop into chronic thromboembolic pulmonary hypertension (CTEPH),or even death,with high case fatality rate.So promptly recognizing the risk factors of prognosis is of great significance in improving the prognosis of patients with PTE.Through retrieving literature from PubMed,CNKI and so on,this review focused on the factors affecting prognosis of PTE.Various factors affect the prognosis of PTE.The prognosis of PTE is closely relevant to PESI scoring system,PTE risk stratification,treatment options and complications of treatment.And it also has inevitable connection with serum markers such as BNP or NT-proBNP,troponin and D-dimer.PESI scoring system is the most widely and effectively used indicator to evaluate the prognosis of PTE,among which elder patients and patients with malignant tumor have more incidence rate of adverse events.So advanced age and malignant tumor may be independent risk factors which affect the prognosis of PTE.Clinically for those PTE patients with prognostic risk factors,we should be on high alert,adopt individualized treatment,and strengthen the standardized management of patients,thus improving the prognosis and increasing the survival rate.