Pang Wenyi, Zhang Zhu, Wang Zenghui, Zhen Kaiyuan, Zhang Meng, Zhang Yunxia, Gao Qian, Zhang Shuai, Tao Xincao, Wan Jun, Xie Wanmu, Zhai Zhenguo
Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
National Center for Respiratory Medicine, Beijing, China.
Front Med (Lausanne). 2021 Oct 26;8:721294. doi: 10.3389/fmed.2021.721294. eCollection 2021.
To summarize the incidence of right heart catheter diagnosed chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE) in a meta-analysis. Cohort studies reporting the incidence of CTEPH after acute PE were identified search of Medline, Embase, China National Knowledge Infrastructure and WanFang databases. Twenty-two cohort studies with 5,834 acute PE patients were included. Pooled results showed that the overall incidence of CTEPH was 2.82% (95% CI: 2.11-3.53%). Subgroup analyses showed higher incidence of CTEPH in Asians than Europeans (5.08 vs. 1.96%, = 0.01), in retrospective cohorts than prospective cohorts (4.75 vs. 2.47%, = 0.02), and in studies with smaller sample size than those with larger sample size (4.57 vs. 1.71%, < 0.001). Stratified analyses showed previous venous thromboembolic events and unprovoked PE were both significantly associated with increased risk of CTEPH (OR = 2.57 and 2.71, respectively; both < 0.01). The incidence of CTEPH after acute PE is ~3% and the incidence is higher in Asians than Europeans. Efforts should be made for the early diagnosis and treatment of CTEPH in PE patients, particularly for high-risk population.
在一项荟萃分析中总结经右心导管检查诊断的急性肺栓塞（PE）后慢性血栓栓塞性肺动脉高压（CTEPH）的发生率。通过检索Medline、Embase、中国知网和万方数据库，确定了报告急性PE后CTEPH发生率的队列研究。纳入了22项包含5834例急性PE患者的队列研究。汇总结果显示，CTEPH的总体发生率为2.82%（95%CI：2.11 - 3.53%）。亚组分析显示，亚洲人CTEPH的发生率高于欧洲人（5.08%对1.96%，P = 0.01），回顾性队列高于前瞻性队列（4.75%对2.47%，P = 0.02），样本量较小的研究高于样本量较大的研究（4.57%对1.71%，P < 0.001）。分层分析显示，既往静脉血栓栓塞事件和不明原因的PE均与CTEPH风险增加显著相关（OR分别为2.57和2.71；均P < 0.01）。急性PE后CTEPH的发生率约为3%，亚洲人的发生率高于欧洲人。应努力对PE患者，尤其是高危人群进行CTEPH的早期诊断和治疗。
