老年急性肺血栓栓塞症患者627例长期预后及影响因素分析

The long-term prognosis and influencing factors of acute pulmonary thromboembolism in the elderly: analysis of 627 cases

摘要:

目的 探讨老年肺血栓栓塞症（PTE）患者的临床特点、预后及影响生存的因素。方法 入选2006年1月1日至2011年3月31日期间在首都医科大学附属北京朝阳医院确诊为急性PTE的患者627例。按年龄分为两组：≥65岁组（n＝309）和＜65岁组（n＝318）。比较两组患者的临床资料，分析对预后及生存的影响因素。结果 两组间静脉血栓栓塞症（VTE）复发率比较，差异无统计学意义（P＝0.157）；≥ 65岁患者组全因死亡率明显高于＜65岁患者组（P＜0.001）。分析具体死亡原因后发现，≥65岁组中死于其他明确原因（包括重症感染、呼吸衰竭、肾脏衰竭、多脏器功能衰竭等）的患者比例明显高于＜65岁组（P＝0.006）。行Cox单因素分析，显示年龄、体质量指数（BMI）、合并恶性肿瘤、肺动脉收缩压（SPAP）＞50mmHg、PTE继发于2个月内的手术、较长的抗凝疗程与发生死亡相关。行Cox多因素分析，结果提示只有年龄、合并恶性肿瘤、SPAP＞50mmHg、PTE继发于2个月内的手术及较长的抗凝疗程是发生死亡的高危因素。结论 老年PTE患者由于合并慢性基础疾病而导致长期预后不佳，应引起临床医师的重视，在规范化诊治PTE之外，应重视合并症的正规治疗。

Abstract:

Objective To investigate the clinical features, prognosis and factors influencing survival for the elderly patients with pulmonary thromboembolism (PTE). Methods A total of 627 patients with identified acute PTE admitted in Beijing Chaoyang Hospital from January 2006 to March 2011 were enrolled in this study. They were divided into the ≥65 year-old group (n＝309) and the ＜65 year-old group (n＝318). Their clinical data were compared to analyze the influencing factors of prognosis and survival. Results There was no significant difference in recurrence of venous thromboembolism (VTE) between the two groups (P＝0.157). But the older group had obviously higher mortality than the younger one (P＜0.001). The analysis on cause of death indicated that there were more patients died of other definite causes (including severe infection, respiratory failure, renal failure, multiple organ failure, and so on) in the ≥65 year-old group than those in the younger group (P＝0.006). Univariate Cox analysis showed that age, body mass index (BMI), complication of malignant tumor, systolic pulmonary artery pressure (SPAP) ＞50mmHg, surgery secondary to PTE within 2 months, and long-term anticoagulant therapy were correlated with the occurrence of death. But further multivariate Cox analysis suggested that only age, malignant tumor, SPAP ＞50mmHg, surgery within 2 months after PTE, and long-term anticoagulant therapy be high risk factors for death. Conclusion The elderly PTE patients have poor long-term prognosis due to their complications of chronic comorbidities. Physicians should pay attention to this, and emphasize regular treatment for their complications in addition to the standard diagnosis and treatment of PTE.