Kucher Nils, Tapson Victor F, Goldhaber Samuel Z
Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Thromb Haemost. 2005 Mar;93(3):494-8. doi: 10.1160/TH04-09-0587.
In patients with deep vein thrombosis (DVT), the factors which predispose to concomitant symptomatic pulmonary embolism (PE) have remained uncertain. From a prospective cohort of 5,451 consecutive patients with ultrasound-confirmed DVT, we analyzed 4,211 patients with a known status for presence (n=639) or absence (n=3572) of symptomatic PE. Age and gender were similar in DVT plus PE (63.7+/-15.6 years; 49% men) and DVT patients (63.4+/-17.3 years; 46% men). Body mass index (BMI) was higher in patients with DVT plus PE (median 29.0, range 15.4-67.0 kg/m2) than in patients with DVT (median 26.8, range 9.7-64.4 kg/m2; p<0.001). Chronic lung disease (17% vs. 12%; p<0.001), a personal history of PE (11% vs. 6%; p<0.001), and a family history of DVT or PE (8% vs. 4%; p<0.001) were more frequent in DVT plus PE patients. Twenty-seven percent of DVT plus PE patients received prophylaxis prior to the thromboembolic event compared with 32% of DVT patients (p=0.002). Proximal DVT (OR 1.84, 95% CI 1.39-2.43), prior PE (OR 1.68, 95% CI 1.20-2.35), obesity (BMI >30 kg/m2) (OR 1.65, 95% CI 1.33-2.04), chronic lung disease (OR 1.51, 95% CI 1.13-2.01), as well as omission of prophylaxis (OR 1.30, 95% CI 1.04-1.64) emerged as independent predictors of concomitant symptomatic PE.
在深静脉血栓形成（DVT）患者中，易并发有症状肺栓塞（PE）的因素仍不明确。在一个由5451例经超声确诊为DVT的连续患者组成的前瞻性队列中，我们分析了4211例已知有无症状PE的患者（有症状PE者n = 639例，无症状PE者n = 3572例）。DVT合并PE患者（63.7±15.6岁；男性占49%）和DVT患者（63.4±17.3岁；男性占46%）的年龄和性别相似。DVT合并PE患者的体重指数（BMI）（中位数29.0，范围15.4 - 67.0 kg/m²）高于DVT患者（中位数26.8，范围9.7 - 64.4 kg/m²；p<0.001）。慢性肺病（17%对12%；p<0.001）、PE个人史（11%对6%；p<0.001）以及DVT或PE家族史（8%对4%；p<0.001）在DVT合并PE患者中更为常见。27%的DVT合并PE患者在血栓栓塞事件发生前接受了预防，而DVT患者这一比例为32%（p = 0.002）。近端DVT（比值比[OR]1.84，95%置信区间[CI]1.39 - 2.43）、既往PE（OR 1.68，95%CI 1.20 - 2.35）、肥胖（BMI>30 kg/m²）（OR 1.65，95%CI 1.33 - 2.04）、慢性肺病（OR 1.51，95%CI 1.13 - 2.01）以及未进行预防（OR 1.30，95%CI 1.04 - 1.64）是并发有症状PE的独立预测因素。
