Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Blood. 2013 Aug 15;122(7):1144-9; quiz 1329. doi: 10.1182/blood-2013-04-497545. Epub 2013 Jun 4.
The clinical significance of subsegmental pulmonary embolism (SSPE) remains to be determined. This study aimed to investigate whether SSPE forms a distinct subset of thromboembolic disease compared with more proximally located pulmonary embolism (PE). We analyzed 3728 consecutive patients with clinically suspected PE. SSPE patients were contrasted to patients with more proximal PE and to patients in whom suspected PE was ruled out, in regards of the prevalence of thromboembolic risk factors and the 3-month risks of recurrent venous thromboembolism (VTE) and mortality. PE was confirmed in 748 patients, of whom 116 (16%) had SSPE; PE was ruled out in 2980 patients. No differences were seen in the prevalence of VTE risk factors, the 3-month risk of recurrent VTE (3.6% vs 2.5%; P = .42), and mortality (10.7% vs 6.5%; P = .17) between patients with SSPE and those with more proximal PE. When compared with patients without PE, aged >60 years, recent surgery, estrogen use, and male gender were found to be independent predictors for SSPE, and patients with SSPE were at an increased risk of VTE during follow-up (hazard ratio: 3.8; 95% CI: 1.3-11.1). This study indicates that patients with SSPE mimic those with more proximally located PE in regards to their risk profile and clinical outcome.
亚段肺栓塞（SSPE）的临床意义仍有待确定。本研究旨在探讨 SSPE 是否与更靠近近端的肺栓塞（PE）相比形成血栓栓塞疾病的独特亚组。我们分析了 3728 例连续疑似 PE 的患者。在血栓栓塞危险因素的患病率和 3 个月内复发性静脉血栓栓塞（VTE）和死亡率方面，将 SSPE 患者与更靠近近端的 PE 患者和疑似 PE 排除的患者进行对比。在 748 例确诊 PE 的患者中，有 116 例（16%）为 SSPE；在 2980 例排除 PE 的患者中。SSPE 患者和更靠近近端的 PE 患者在 VTE 危险因素的患病率、3 个月内复发性 VTE 的风险（3.6%比 2.5%；P=.42）和死亡率（10.7%比 6.5%；P=.17）方面无差异。与没有 PE 的患者相比，年龄>60 岁、近期手术、雌激素使用和男性是 SSPE 的独立预测因素，并且 SSPE 患者在随访期间 VTE 的风险增加（风险比：3.8；95%CI：1.3-11.1）。本研究表明，SSPE 患者在风险特征和临床结局方面与更靠近近端的 PE 患者相似。
