Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China.
Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China.
Int J Cardiol. 2021 Dec 15;345:111-117. doi: 10.1016/j.ijcard.2021.10.151. Epub 2021 Oct 30.
Only one large series has been reported on fat embolism syndrome (FES), a condition caused by fat globules release into the circulation, primarily as consequence of bone fracture. Thus, more data on clinical features, therapies, and prognosis are needed.
The study screened 1090 manuscripts in PubMed and Web of Science on cases of FES published from June 2010 to June 2020. The authors identified 124 studies and included in the pooled-analysis 135 patients (>14 years), plus one additional unpublished case managed in Tongji hospital. All had confirmed diagnosis of FES with complete clinical data. The median age at presentation was 39 years, and 82 (61.8%) were men. FES was predominantly associated with bone fractures (78, 57.4%), particularly femur fracture (59, 43.4%). The most common clinical finding at the onset was respiratory abnormalities in 34.6% of all clinical presentations. Therapies included respiratory supportive care in 127 (93.4%) patients, application of corticosteroids in 22 (16.2%) and anticoagulant in 5 (3.7%) cases. Overall mortality was 30.2% (N = 41), and logistic regression analysis showed that corticosteroid therapy was significantly associated with reduced mortality with an OR of 0.143 (95%CI 0.029-0.711), while age ≥ 65 years and non-orthopedic conditions were significantly associated with increased mortality with an OR of 4.816 (95%CI 1.638-14.160) and 4.785 (95%CI 1.019-22.474).
FES has been associated with a larger mortality rate than previously observed, although publication bias can have led to overestimation of mortality. Finally, a potential protective effect of corticosteroid therapy has been suggested by the current analysis.
脂肪栓塞综合征（FES）是一种由脂肪球释放到循环系统中引起的病症，主要是由于骨折引起的。因此，需要更多关于其临床特征、治疗方法和预后的数据。
本研究在 PubMed 和 Web of Science 上筛选了 2010 年 6 月至 2020 年 6 月期间发表的 FES 病例的 1090 篇文献。作者确定了 124 项研究，并对其中 135 例（年龄大于 14 岁）患者进行了汇总分析，此外还包括同济医院管理的一例未发表病例。所有患者均有 FES 的确诊诊断和完整的临床数据。发病时的中位年龄为 39 岁，82 例（61.8%）为男性。FES 主要与骨折（78 例，57.4%）相关，尤其是股骨骨折（59 例，43.4%）。所有患者最常见的首发临床症状是呼吸异常，占所有临床表现的 34.6%。治疗方法包括 127 例（93.4%）患者的呼吸支持治疗、22 例（16.2%）患者的皮质激素治疗和 5 例（3.7%）患者的抗凝治疗。总死亡率为 30.2%（N=41），logistic 回归分析显示，皮质激素治疗与死亡率降低显著相关，比值比（OR）为 0.143（95%可信区间 0.029-0.711），而年龄≥65 岁和非骨科疾病与死亡率升高显著相关，OR 分别为 4.816（95%可信区间 1.638-14.160）和 4.785（95%可信区间 1.019-22.474）。
FES 的死亡率高于以往观察到的死亡率，尽管发表偏倚可能导致死亡率高估。最后，本分析提示皮质激素治疗可能具有潜在的保护作用。
