特发性肺栓塞临床特征分析

沈世茉; 周华; 周建英

doi:10.13201/j.issn.1001-1439.2016.08.011

特发性肺栓塞临床特征分析

- 1 浙江大学医学院附属第一医院呼吸内科(杭州, 310003);
- 2 宁波市医疗中心李惠利医院呼吸内科
基金项目:
浙江省重大科技专项重大社会发展项目(No:2012C13022-2)

详细信息

通讯作者: 周建英,E-mail:drzjy@163.com

中图分类号: R587.1

收稿日期: 2016-02-20

Clinical characteristics and radiological findings of idiopathic pulmonary embolism:a retrospective study

- 1 Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China;
- 2 Department of Respiratory Medicine, Li Huili Hospital, Ningbo Medical Center

More Information

Corresponding author: ZHOU Jian-ying, E-mail: drzjy@163.com

Received Date: 20 February 2016

摘要

摘要: 目的: 探讨特发性肺栓塞的临床特征,提高其诊治水平。方法: 对298例肺栓塞患者进行回顾性分析,根据有无危险因素分为非特发性肺栓塞(provoked pulmonary embolism,pPE)组和特发性肺栓塞(idiopathic pulmonary embolism,iPE)组,比较两组的临床和影像学特征。结果: 入选患者pPE组247例、iPE组51例。两组患者除下肢疼痛外,其余临床症状均无统计学差异。iPE组下肢疼痛或水肿、下肢深静脉血栓发生率、CT见胸膜下楔形影或线性不张比例、起始肺叶或段及以下动脉累及率高于pPE组(P<0.05),而CT示胸腔或心包积液比例、D-二聚体水平、发病年龄低于pPE组(P<0.05)。结论: 特发性肺栓塞发病年龄相对较轻,且无危险因素提示,Wells简化评分常为假阴性,临床易漏诊、误诊,但本研究发现,对于下肢水肿、疼痛且胸部CT示胸膜下楔形影患者,应尽早行双下肢超声检查、CTPA以提高特发性肺栓塞早期诊断。
- 特发性肺栓塞 /
- 非特发性肺栓塞 /
- 临床特征 /
- 影像学特征
Abstract: Objective: The aim of this study is to characterize the clinical and radiological features of idiopathic pulmonary embolism and improve the understanding of iPE.Method: The 298 patients of confirmed pulmonary embolism were enrolled in this study.They were subsequently divided into iPE or pPE groups after the assessment of risk factors for pulmonary embolism.The clinical characteristics and radiological features were compared between the two groups of pPEs and iPEs.Result::In the overall 298 patients,there were 51 patients of iPE,and 247 patients of pPE.Most of the symptoms did not differ significantly in the two groups except the incidence of pain in the lower extremities.Patients of iPE had higher frequencies of pain and edema in the lower extremities and deep vein thrombosis.Patients of iPE had higher frequencies of wedge-shaped density or linear atelectasis while lower frequencies of pleural effusion or hydropericardium as shown in CTPA.Filling defects at lobular or further distant level of pulmonary arterial branch were observed more frequently in iPE group than that of pPE group.Patients of iPE were younger and had lower levels of D-Dimer.Conclusion::iPEs is an easily missed or misdiagnosed disease that tends to affect younger people.The predictive value of simplified wells rule is quite limited for iPE.Patients with pain and edema in the lower extremities should be examined by ultrasonography as early as possible and those with wedge-shaped density or linear atelectasis on CT may need CPTA further.
- idiopathic pulmonary embolism /
- provoked pulmonary embolism /
- clinical characteristics /
- CTPA

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