Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Respiration. 2010;80(6):500-8. doi: 10.1159/000277929. Epub 2010 Jan 21.
The clinical relevance of emboli limited to the segmental or sub-segmental pulmonary arteries and the role of anticoagulation in patients with these conditions remains to be clarified.
To determine the clinical characteristics and treatment outcomes of peripheral pulmonary embolism (PE), and in particular, isolated sub-segmental PE (ISSPE).
We reviewed the data for 334 patients who were diagnosed with a PE by computed tomographic (CT) pulmonary angiography and indirect CT venography.
All patients were classified into one of three groups: central (245 patients, 73.4%); segmental (67 patients, 20.1%), and sub-segmental (22 patients, 6.6%). An incidental CT finding (63.6%) was the most common presentation in the segmental and sub-segmental groups. Compared with the central group, the sub-segmental group had less frequent proximal deep venous thrombosis (14 vs. 47%, Bonferroni's corrected p = 0.002), and greater preservation of oxygenation levels (p < 0.05) without hemodynamic instability. The recurrence of PE and deaths related to PE did not occur in the sub-segmental group, although approximately 30% of the patients did not receive anticoagulation therapy.
Patients with ISSPE may have a more benign clinical presentation, as compared to the central type, and may follow a good clinical course without mortality or recurrence.
局限于肺段或亚段肺动脉内的栓子的临床相关性以及这些情况下抗凝治疗的作用仍需阐明。
明确外周型肺栓塞（PE）的临床特征和治疗结局，尤其是孤立性亚段型 PE（ISSPE）。
我们回顾了 334 例经 CT 肺动脉造影和间接 CT 静脉造影诊断为 PE 的患者的数据。
所有患者分为三组：中央型（245 例，73.4%）；节段型（67 例，20.1%）和亚段型（22 例，6.6%）。节段型和亚段型中最常见的表现是偶然发现 CT 结果（63.6%）。与中央型相比，亚段型近端深静脉血栓形成的发生率较低（14%比 47%，Bonferroni 校正后 p=0.002），氧合水平的保存更好（p<0.05），无血流动力学不稳定。亚段型组未发生 PE 复发和与 PE 相关的死亡，但约 30%的患者未接受抗凝治疗。
与中央型相比，ISSPE 患者的临床表现可能更为良性，且临床过程良好，无死亡或复发。
