Yamaki T, Nozaki M, Sakurai H, Takeuchi M, Soejima K, Kono T
Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
Eur J Vasc Endovasc Surg. 2009 Feb;37(2):225-31. doi: 10.1016/j.ejvs.2008.08.018. Epub 2008 Oct 14.
To investigate the presence of lower limb deep vein thrombosis (DVT) and prognosis in patients with symptomatic pulmonary embolism (PE).
A total of 203 consecutive referral patients with PE were included. The distribution of DVT was evaluated with compression ultrasound (CUS), and all patients were then followed for 12 months for investigation of recurrence of venous thromboembolism (VTE) and fatal events as adverse outcome.
The mean age of the patients was 62.8 years, and 78 (38.4%) were males. DVT was found in 118 (58.1%) patients. Of these patients, 61 (30.0%) had proximal DVT. Multivariate analysis demonstrated that active cancer, inadequate anticoagulation, leg symptoms, male gender, presence of DVT, presence of proximal DVT, and previous DVT were independent risk factors for adverse outcome. A clinical risk score ranging from 0 to 10 points was generated on the basis of multivariate regression coefficients. Receiver operating characteristic curve analysis showed that an appropriate cut-off point for discriminating between the presence and the absence of an adverse event was 4. Using this category, 166 (81.8%) patients were classified as low risk and 37 (18.2%) as high risk for adverse outcome. The adverse event rates were 6.0% for the low-risk group and 59.5% for the high-risk group.
This study has confirmed the clinical significance of surveillance CUS in patients with a first episode of PE. Furthermore, a simple risk score on the basis of available variables can identify patients at risk of an adverse outcome in patients with PE.
调查有症状肺栓塞（PE）患者下肢深静脉血栓形成（DVT）的情况及预后。
纳入203例连续转诊的PE患者。采用压迫超声（CUS）评估DVT的分布情况，随后对所有患者进行12个月的随访，以调查静脉血栓栓塞症（VTE）复发及致命事件等不良结局。
患者的平均年龄为62.8岁，男性78例（38.4%）。118例（58.1%）患者发现有DVT。其中，61例（30.0%）有近端DVT。多因素分析表明，活动性癌症、抗凝不足、腿部症状、男性、存在DVT、存在近端DVT及既往有DVT是不良结局的独立危险因素。根据多因素回归系数生成了一个0至10分的临床风险评分。受试者工作特征曲线分析显示，区分有无不良事件的合适切点为4分。采用该分类方法，166例（81.8%）患者被分类为低风险，37例（18.2%）为高风险不良结局。低风险组的不良事件发生率为6.0%，高风险组为59.5%。
本研究证实了首次发作PE患者进行监测CUS的临床意义。此外，基于现有变量的简单风险评分可识别PE患者中存在不良结局风险的患者。
