Liu Weifang, Xie Sheng, Liang Tian, Chang Feiyan, Liu Min, Zhai Zhenguo
Department of Radiology, Civil Aviation General Hospital, Beijing, China.
Department of Radiology, China-Japan Friendship Hospital, Beijing, China.
Quant Imaging Med Surg. 2022 Aug;12(8):4047-4058. doi: 10.21037/qims-21-753.
Predicting the progression of acute pulmonary embolism to chronic pulmonary thromboembolism (CPTE) disease is essential to monitoring and improving the long-term prognosis of pulmonary embolism. We explored the risk factors for chronic persistence of thromboembolism after acute pulmonary embolism.
Cases with newly onset acute pulmonary embolism in the China-Japan Friendship Hospital from November 2016 to November 2019 were retrospectively analyzed. The clinical characteristics, serological examination results, and treatment strategies of acute pulmonary embolism patients were obtained through the electronic medical record system (Goodwill E-Health Info Co., Ltd.). Imaging parameters on computed tomography pulmonary angiography (CTPA) images at the onset of the acute pulmonary embolism were measured and counted. Notably, we propose a new parameter based on CTPA images: the ratio of S (sum of residual segmental pulmonary artery diameter) to MPA (the main pulmonary artery diameter) (S/MPA). After 3 months of regular treatment for acute pulmonary embolism, patients were classified into a CPTE group or a non-CPTE group based on the presence of residual embolus. All data were compared between the CPTE group and non-CPTE group. Furthermore, logistic regression analysis was used to investigate risk factors for the progression of acute pulmonary embolism to CPTE.
A total of 77 cases (male:female = 1:1.26) were included in the study. There were 43 cases (55.84%) in the CPTE group and 34 cases in the non-CPTE group (44.16%). The results of univariate analysis showed that there were statistically significant differences between the 2 groups in risk stratification (χ=8.043; P=0.005), protein S activity (χ=5.551; P=0.018), the ratio of sum of residual segmental pulmonary artery diameter to the main pulmonary artery diameter (S/MPA; t=-2.103; P=0.039), Mastora score (U=362.500; P<0.001), and embolus location (χ=16.969; P<0.001). However, there were no statistically significant differences between the 2 groups in treatment options (P=0.381). According to multivariate logistic-regression analysis, protein S activity <55% (P=0.025), S/MPA ≥1.97 (P=0.011), and an embolus being located in the central pulmonary artery (P<0.001) were independent risk factors for chronic persistence of thromboembolism following acute pulmonary embolism.
The protein S activity, location of the embolus, and S/MPA on CTPA at the onset of acute pulmonary embolism may suggest the progression of acute pulmonary embolism to CPTE.
预测急性肺栓塞进展为慢性血栓栓塞性肺动脉高压（CPTE）疾病对于监测和改善肺栓塞的长期预后至关重要。我们探讨了急性肺栓塞后血栓栓塞长期持续存在的危险因素。
回顾性分析2016年11月至2019年11月在中国-日本友好医院新诊断为急性肺栓塞的病例。通过电子病历系统（嘉和一品健康信息有限公司）获取急性肺栓塞患者的临床特征、血清学检查结果及治疗策略。测量并统计急性肺栓塞发作时计算机断层扫描肺动脉造影（CTPA）图像上的影像学参数。值得注意的是，我们基于CTPA图像提出了一个新参数：S（残余节段性肺动脉直径总和）与MPA（主肺动脉直径）的比值（S/MPA）。在对急性肺栓塞进行3个月的常规治疗后，根据残余栓子的存在情况将患者分为CPTE组或非CPTE组。比较CPTE组和非CPTE组之间的所有数据。此外，采用逻辑回归分析探讨急性肺栓塞进展为CPTE的危险因素。
本研究共纳入77例患者（男∶女 = 1∶1.26）。CPTE组43例（55.84%），非CPTE组34例（44.16%）。单因素分析结果显示，两组在危险分层（χ=8.043；P=0.005）、蛋白S活性（χ=5.551；P=0.018）、残余节段性肺动脉直径总和与主肺动脉直径的比值（S/MPA；t=-2.103；P=0.039）、马斯特拉评分（U=362.500；P<0.001）及栓子位置（χ=16.969；P<0.001）方面存在统计学差异。然而，两组在治疗方案方面无统计学差异（P=0.381）。根据多因素逻辑回归分析，蛋白S活性<55%（P=0.025）、S/MPA≥1.97（P=0.011）及栓子位于中央肺动脉（P<0.001）是急性肺栓塞后血栓栓塞长期持续存在的独立危险因素。
急性肺栓塞发作时的蛋白S活性、栓子位置及CTPA上的S/MPA可能提示急性肺栓塞进展为CPTE。
