EHJ新发现:急性肺栓塞后发生慢性血栓栓塞性肺动脉高压的概率约2.3%

2022-05-03 网络 网络

系统地评估急性肺栓塞(PE)的晚期结果,并研究符合前瞻性标准的PE后损伤(PPEI)的临床意义。

直到最近,肺栓塞 (PE) 的管理主要集中在降低早期(30 天或院内)死亡的风险,这取决于指数发作的临床严重程度、合并症和急性右心室(RV)压力超负荷和功能障碍。专注于治疗急性中危或低危PE 的随机研究是根据短期主要结果设计的,长期随访的治疗试验主要服务于确定最佳持续时间的目标以及抗凝和二级预防的方案。

在急性 PE 的同时,慢性血栓栓塞性肺动脉高压 (CTEPH) 的诊断和治疗也取得了重大进展。事实上,CTEPH 被认为是急性 PE 的晚期并发症或后遗症,由多种易感因素影响下有缺陷的血管重塑和肺血栓消退引起。然而,PE 后 CTEPH 的总体发病率似乎很低,这一事实不能证明对急性 PE 发作的所有幸存者进行常规 CTEPH 筛查是合理的。因此,迫切需要制定和验证后续评估策略,目的是根据对 CTEPH 的高度怀疑来确定高级诊断工作的“真正”候选者。人们进一步认识到,应进一步关注患者报告的长期症状,以便表征和治疗更大的患者群体,这些患者群体在 PE 后遭受持续的功能限制和生活质量 (QoL) 降低。欧洲心脏病学会 (ESC) 2019 年指南首次提出的 PE 后评估算法在这方面是一种潜在有用的临床工具,但在现阶段,它主要基于专家共识,而不是前瞻性获得的数据。

为了缩小这一证据差距,我们在急性肺栓塞 (FOCUS) 研究后进行了前瞻性多中心随访。FOCUS 研究是在具有急性 PE 和慢性肺动脉高压/CTEPH 专业知识的大型三级中心进行的,该研究协调了他们的临床方案,并前瞻性地对连续的急性 PE 患者/所有来者进行了为期 2 年的综合随访计划。这项观察性研究的目的是系统地评估急性 PE 后的广泛晚期结果,特别是评估前瞻性定义的临床相关的 PE 后损伤 (PPEI) 标准。这些可能作为 CTEPH 可能存在以及临床和功能性 PE 后遗症的更广泛临床范围的警告信号。

研究方法和结果:

在德国的17个大型中心进行了一项前瞻性的多中心观察队列研究。通过标准化的评估计划和预先规定的3、12和24个月的访问,对确认的急性症状性PE的成人连续患者进行了跟踪。

共同主要结果是:(i)诊断为慢性血栓栓塞性肺动脉高压(CTEPH),以及(ii)PPEI,即随访期间临床、功能、生化和影像参数持续或恶化的组合。共有1017名患者(45%为女性,中位年龄64岁)被纳入主要分析。
他们在PE诊断后被随访的时间中位数为732天。16名(1.6%)患者在中位数129天后被诊断为CTEPH;估计2年的累积发病率为2.3%(1.2-4.4%)。总的来说,880名患者可进行PPEI评估;2年的累积发病率为16.0%(95%置信区间为12.8-20.8%)。
在随访期间,PPEI有助于识别16名被诊断为CTEPH的患者中的15名(CTEPH与无CTEPH的危险比为393;95%置信区间为73-2119)。
与无PPEI的患者相比,有PPEI的患者再次住院和死亡的风险更高,生活质量也更差。

研究结论:

在这项前瞻性研究中,CTEPH的2年累计发病率为2.3%,但根据标准化标准诊断的PPEI却很常见。我们的研究结果支持对急性PE后的患者进行系统随访,并可能有助于优化PE后护理的指南建议和算法。

 

文献参考:

Valerio L. Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study. Eur Heart J. 2022 Apr 28:ehac206. doi: 10.1093/eurheartj/ehac206. Epub ahead of print. PMID: 35484821.

 

 

 

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    2022-05-04 萌宝嘟嘟

    好东西,谢谢分享

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    2022-05-04 清漩

    学习#学习#

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1921347, encodeId=b498192134e62, content=<a href='/topic/show?id=6bfa58133ef' target=_blank style='color:#2F92EE;'>#新发现#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58133, encryptionId=6bfa58133ef, topicName=新发现)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Wed Mar 15 05:50:56 CST 2023, time=2023-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1925589, encodeId=bcf6192558925, content=<a href='/topic/show?id=26d633354c9' target=_blank style='color:#2F92EE;'>#动脉高压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33354, encryptionId=26d633354c9, topicName=动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Mon Dec 19 05:50:56 CST 2022, time=2022-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216693, encodeId=b45212166939b, content=好东西,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0be2111725, createdName=萌宝嘟嘟, createdTime=Wed May 04 06:46:27 CST 2022, time=2022-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216721, encodeId=a6811216e2174, content=学习<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bdd5596550, createdName=清漩, createdTime=Wed May 04 10:28:03 CST 2022, time=2022-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217260, encodeId=f745121e26076, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bdd5596550, createdName=清漩, createdTime=Fri May 06 08:11:20 CST 2022, time=2022-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217441, encodeId=9ee3121e44168, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=f2045610512, createdName=将军的九分裤, createdTime=Fri May 06 21:23:53 CST 2022, time=2022-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1323500, encodeId=4755132350033, content=<a href='/topic/show?id=a94a52391e7' target=_blank style='color:#2F92EE;'>#急性肺栓塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52391, encryptionId=a94a52391e7, topicName=急性肺栓塞)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJnkE6UvGFfMS41qV0RicWvVTTeLMicqibeZH5GqO4YhNicyl1Y9jFhylIUBn9ntPYy9jhk5hrfic5cRYw/132, createdBy=5f822500020, createdName=ms5236388012055669, createdTime=Wed May 04 12:50:56 CST 2022, time=2022-05-04, status=1, ipAttribution=)]
    2022-05-06 清漩

    #学习#学习

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  6. [GetPortalCommentsPageByObjectIdResponse(id=1921347, encodeId=b498192134e62, content=<a href='/topic/show?id=6bfa58133ef' target=_blank style='color:#2F92EE;'>#新发现#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58133, encryptionId=6bfa58133ef, topicName=新发现)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Wed Mar 15 05:50:56 CST 2023, time=2023-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1925589, encodeId=bcf6192558925, content=<a href='/topic/show?id=26d633354c9' target=_blank style='color:#2F92EE;'>#动脉高压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33354, encryptionId=26d633354c9, topicName=动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Mon Dec 19 05:50:56 CST 2022, time=2022-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216693, encodeId=b45212166939b, content=好东西,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0be2111725, createdName=萌宝嘟嘟, createdTime=Wed May 04 06:46:27 CST 2022, time=2022-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216721, encodeId=a6811216e2174, content=学习<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bdd5596550, createdName=清漩, createdTime=Wed May 04 10:28:03 CST 2022, time=2022-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217260, encodeId=f745121e26076, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bdd5596550, createdName=清漩, createdTime=Fri May 06 08:11:20 CST 2022, time=2022-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217441, encodeId=9ee3121e44168, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=f2045610512, createdName=将军的九分裤, createdTime=Fri May 06 21:23:53 CST 2022, time=2022-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1323500, encodeId=4755132350033, content=<a href='/topic/show?id=a94a52391e7' target=_blank style='color:#2F92EE;'>#急性肺栓塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52391, encryptionId=a94a52391e7, topicName=急性肺栓塞)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJnkE6UvGFfMS41qV0RicWvVTTeLMicqibeZH5GqO4YhNicyl1Y9jFhylIUBn9ntPYy9jhk5hrfic5cRYw/132, createdBy=5f822500020, createdName=ms5236388012055669, createdTime=Wed May 04 12:50:56 CST 2022, time=2022-05-04, status=1, ipAttribution=)]
    2022-05-06 将军的九分裤

    学到了

    1

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  7. [GetPortalCommentsPageByObjectIdResponse(id=1921347, encodeId=b498192134e62, content=<a href='/topic/show?id=6bfa58133ef' target=_blank style='color:#2F92EE;'>#新发现#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58133, encryptionId=6bfa58133ef, topicName=新发现)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Wed Mar 15 05:50:56 CST 2023, time=2023-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1925589, encodeId=bcf6192558925, content=<a href='/topic/show?id=26d633354c9' target=_blank style='color:#2F92EE;'>#动脉高压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33354, encryptionId=26d633354c9, topicName=动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Mon Dec 19 05:50:56 CST 2022, time=2022-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216693, encodeId=b45212166939b, content=好东西,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0be2111725, createdName=萌宝嘟嘟, createdTime=Wed May 04 06:46:27 CST 2022, time=2022-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216721, encodeId=a6811216e2174, content=学习<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bdd5596550, createdName=清漩, createdTime=Wed May 04 10:28:03 CST 2022, time=2022-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217260, encodeId=f745121e26076, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bdd5596550, createdName=清漩, createdTime=Fri May 06 08:11:20 CST 2022, time=2022-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217441, encodeId=9ee3121e44168, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=f2045610512, createdName=将军的九分裤, createdTime=Fri May 06 21:23:53 CST 2022, time=2022-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1323500, encodeId=4755132350033, content=<a href='/topic/show?id=a94a52391e7' target=_blank style='color:#2F92EE;'>#急性肺栓塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52391, encryptionId=a94a52391e7, topicName=急性肺栓塞)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJnkE6UvGFfMS41qV0RicWvVTTeLMicqibeZH5GqO4YhNicyl1Y9jFhylIUBn9ntPYy9jhk5hrfic5cRYw/132, createdBy=5f822500020, createdName=ms5236388012055669, createdTime=Wed May 04 12:50:56 CST 2022, time=2022-05-04, status=1, ipAttribution=)]

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