Ota Masahiro, Nakamura Mashio, Yamada Norikazu, Yazu Takahiro, Ishikura Ken, Hiraoka Naoto, Tanaka Hideki, Fujioka Hirofumi, Isaka Naoki, Nakano Takeshi
First Department of Internal Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan.
Heart Vessels. 2002 Nov;17(1):7-11. doi: 10.1007/s003800200036.
Despite the advances in our understanding of venous thromboembolic disease, the prevalence of pulmonary thromboembolism (PTE) at autopsy has not changed over 3 decades. When patients survive long enough to have a diagnosis of massive PTE and start receiving treatment, the outlook is considered to be moderately good. However, the diagnosis is often difficult to obtain and is frequently missed. We hypothesize that mortality of acute PTE is reduced by early diagnosis. Eighty-five patients with acute PTE with circulatory failure who survived 1 h after the onset were divided into two groups: the early Dx group consisted of the patients whose disease was diagnosed as acute PTE within 24 h of the onset, and the Late Dx group included patients whose disease was not diagnosed within 24 h of onset, or died without clinical diagnosis between 1 and 24 h after the onset. Overall mortality was significantly low in the Early Dx group compared with that of the Late Dx group (21.6% vs 67.6%, P < 0.0001). Multiple logistic regression analysis demonstrated that a reduction in in-hospital mortality was associated with early diagnosis (odds ratio for in-hospital death, 0.094; 95% confidence interval, 0.03-0.33). The results of our study suggested that early diagnosis might favorably affect the in-hospital clinical outcome of hemodynamically unstable patients with acute PTE.
尽管我们对静脉血栓栓塞性疾病的认识有所进步，但在过去30多年里，尸检时肺血栓栓塞症（PTE）的患病率并未改变。当患者存活时间足够长，得以诊断为大面积PTE并开始接受治疗时，其预后被认为尚可。然而，该诊断往往难以获得，且经常被漏诊。我们推测早期诊断可降低急性PTE的死亡率。85例急性PTE伴循环衰竭且发病后存活1小时的患者被分为两组：早期诊断组由发病后24小时内被诊断为急性PTE的患者组成，晚期诊断组包括发病后24小时内未被诊断或在发病后1至24小时内未临床诊断而死亡的患者。早期诊断组的总体死亡率显著低于晚期诊断组（21.6%对67.6%，P<0.0001）。多因素logistic回归分析表明，早期诊断与住院死亡率降低相关（住院死亡比值比为0.094；95%置信区间为0.03 - 0.33）。我们的研究结果提示，早期诊断可能对血流动力学不稳定的急性PTE患者的住院临床结局产生有利影响。
