Nakamura M, Fujioka H, Yamada N, Sakuma M, Okada O, Nakanishi N, Miyahara Y, Kuriyama T, Kunieda T, Sugimoto T, Nakano T
The First Department of Internal Medicine, Mie University, Tsu, Japan.
Clin Cardiol. 2001 Feb;24(2):132-8. doi: 10.1002/clc.4960240207.
Although the incidence of acute pulmonary thromboembolism (APTE) has been increasing in Japan, patient characteristics, management strategies, and outcome have not yet been assessed in large series.
The present study was designed to investigate the current status of APTE in Japan.
Of a total of 533 registry patients with pulmonary thromboembolism, 309 with APTE were analyzed with respect to clinical symptoms and signs, predisposing factors, diagnostic procedures, estimation of deep venous thrombosis, treatment, and clinical course.
Main risk factors were recent major surgery, cancer, prolonged immobilization, and obesity; only a few patients had coagulopathy and 36% were in cardiogenic shock at presentation. The majority of registry patients underwent lung scans or pulmonary angiography; 30% were diagnosed only by lung scanning. Venous ultrasonography was used in only 34 patients, while 188 patients underwent at least one diagnostic procedure for deep venous thrombosis. Thrombolysis was more frequently performed in patients with cardiogenic shock, and only a few patients received thromboembolectomy. In-hospital mortality rate was 14%. In patients with cardiogenic shock, the mortality rate was reduced by thrombolysis. The predictors of in-hospital mortality were male gender, cardiogenic shock, cancer, and prolonged immobilization.
The patients in this registry had almost the same findings as those in Western patients, except for some points that had the possibility of demonstrating a difference between Westerners and Japanese in the development of APTE. These results can prove especially helpful in planning prospective, randomized trials that will clarify the impact of widely used treatment modalities on the outcome of patients with APTE.
尽管日本急性肺血栓栓塞症（APTE）的发病率一直在上升，但尚未对大量患者的特征、管理策略和预后进行评估。
本研究旨在调查日本APTE的现状。
在总共533例登记的肺血栓栓塞患者中，对309例APTE患者的临床症状和体征、诱发因素、诊断程序、深静脉血栓形成的评估、治疗和临床过程进行了分析。
主要危险因素为近期大手术、癌症、长期制动和肥胖；只有少数患者有凝血功能障碍，36%的患者在就诊时处于心源性休克状态。大多数登记患者接受了肺部扫描或肺血管造影；30%仅通过肺部扫描确诊。仅34例患者使用了静脉超声检查，而188例患者接受了至少一项深静脉血栓形成的诊断程序。心源性休克患者更常进行溶栓治疗，只有少数患者接受了血栓切除术。住院死亡率为14%。在心源性休克患者中，溶栓治疗降低了死亡率。住院死亡的预测因素为男性、心源性休克、癌症和长期制动。
除了某些可能表明西方人和日本人在APTE发病方面存在差异的点外，本登记研究中的患者与西方患者的发现几乎相同。这些结果对于规划前瞻性随机试验特别有帮助，这些试验将阐明广泛使用的治疗方式对APTE患者预后的影响。
