CAJ | 학술논문

目的分析老年急性肺血栓栓塞症(PTE)患者出血事件的发生情况及影响因素.方法前瞻性纳入2009年1月至2013年12月北京朝阳医院初次诊断的年龄≥14岁急性PTE患者共539例,全面采集入选患者的病史、症状、体征、影像学、实验室检查、治疗情况、治疗转归(含病死率、复发率和出血发生率),规律随访3个月,并根据年龄分为非老年组(≤65岁)及老年组(＞65岁),比较两组出血事件的发生情况.结果老年组3个月出血累积发生率及临床相关性非大出血累积发生率显著高于非老年组(20.2%比13.4%,P=0.038及16.7％比10.5%,P=0.043),胃肠道出血的累积发生率显著高于非老年组(6.0%比1.4%,P =0.005),且主要集中在初始治疗1个月内.慢性肝病(P =0.001,OR=9.229)、缺血性脑卒中(P=0.001,OR=6.323)和贫血(P =0.014,OR=3.774)是老年患者大出血的独立危险因素;恶性肿瘤是临床相关性非大出血的独立危险因素(P ＜0.001,OR =3.140);糖尿病(P=0.012,OR=3.711)和贫血(P＜0.001,OR =5.863)是胃肠道出血的独立危险因素.结论老年急性PTE患者总出血累积发生率、临床相关性非大出血发生率高,胃肠道出血发生率高,且主要集中在初始治疗的1个月内,合并疾病的存在可以增加老年PTE患者的出血风险.
목적 분석노년급성폐혈전전새증(PTE)환자출혈사건적발생정황급영향인소.방법 전첨성납입2009년1월지2013년12월북경조양의원초차진단적년령≥14세급성PTE환자공539례,전면채집입선환자적병사、증상、체정、영상학、실험실검사、치료정황、치료전귀(함병사솔、복발솔화출혈발생솔),규률수방3개월,병근거년령분위비노년조(≤65세)급노년조(＞65세),비교량조출혈사건적발생정황.결과 노년조3개월출혈루적발생솔급림상상관성비대출혈루적발생솔현저고우비노년조(20.2%비13.4%,P=0.038급16.7％비10.5%,P=0.043),위장도출혈적루적발생솔현저고우비노년조(6.0%비1.4%,P =0.005),차주요집중재초시치료1개월내.만성간병(P =0.001,OR=9.229)、결혈성뇌졸중(P=0.001,OR=6.323)화빈혈(P =0.014,OR=3.774)시노년환자대출혈적독립위험인소;악성종류시림상상관성비대출혈적독립위험인소(P ＜0.001,OR =3.140);당뇨병(P=0.012,OR=3.711)화빈혈(P＜0.001,OR =5.863)시위장도출혈적독립위험인소.결론 노년급성PTE환자총출혈루적발생솔、림상상관성비대출혈발생솔고,위장도출혈발생솔고,차주요집중재초시치료적1개월내,합병질병적존재가이증가노년PTE환자적출혈풍험.
Objective To investigate the incidences of clinical relevant bleeding events and risk factors in elderly patients with acute pulmonary thromboembolism (PTE).Methods Between January of 2009 and December of 2013, a total of 539 initially diagnosed PTE patients were recruited in our study in Beijing Chao Yang hospital.Basic clinical characteristics, medical history, imaging results, laboratory tests, therapy and outcomes (including mortality, recurrence and incidences of bleeding events) were collected during 3 months' follow-up.All the patients were divided into two groups according to age (≤ 65 years and ＞ 65 years), and these parameters were compared between the two groups.Results Compared with younger patients (≤ 65 years old), older patients (＞ 65 years) had higher incidences of total bleeding, clinical relevant non-major bleeding (20.2% vs 13.4%, P=0.038;16.7% vs 10.5% , P =0.043).The incidence of gastrointestinal bleeding of the elderly was also higher than that of younger patients (6.0% vs 1.4% , P =0.005) and majority of bleeding events were within 1 month after initial treatment.For the elderly, chronic liver diseases (P =0.001, OR =9.229), ischemic stroke (P =0.001, OR =6.323) and anemia (P =0.014, OR =3.774) were independent risk factors for major bleeding, and malignancy (P ＜ 0.001, OR =3.140) was independent risk factor for clinical relevant non-major bleeding.The independent risk factors for gastrointestinal bleeding were diabetes mellitus (P =0.012, OR =3.711) and anemia (P ＜ 0.001, OR =5.863).Conclusions The older PTE patients had higher incidences of total bleeding and clinical relevant non-major bleeding.Gastrointestinal bleeding of the elderly was also higher than that of younger patients and mainly occurred within 1 month after initial treatment.Complications can increase the risk of bleeding in older PTE patients.