儿童肺血栓栓塞诊断的研究进展
Research Progress in the Diagnosis of Pediatric Pulmonary Thromboembolism
DOI: 10.12677/acm.2026.1651926, PDF,   
作者: 旷晓莉, 舒 畅*：重庆医科大学附属儿童医院呼吸科，儿童健康与疾病国家临床医学研究中心，儿童发育疾病研究教育部重点实验室，儿童感染与免疫罕见病重庆市重点实验室，重庆
关键词: 儿童；肺栓塞；诊断；Children； Pulmonary Embolism； Diagnosis
摘要: 肺栓塞(pulmonary embolism, PE)是以各种栓子阻塞肺动脉系统引起肺循环障碍的一组疾病或临床综合征。近年来儿童肺栓塞病例报道日益增多，研究显示，儿童PE报道发病率为0.005%，但病死率高达26%。患儿临床表现无特异性。目前缺乏儿童大样本临床研究数据，评估及诊治儿童肺栓塞的方法尚无统一标准。本文就近年来对儿童肺栓塞的识别及诊断方法进行综述，以期为临床医师提供早期识别及诊断指导。
Abstract: Pulmonary embolism (PE) is a group of diseases or clinical syndromes caused by various emboli obstructing the pulmonary arterial system, leading to pulmonary circulation disorders. In recent years, reports of pediatric pulmonary embolism cases have increased. Studies show that the reported incidence of PE in children is 0.005%, but the mortality rate is as high as 26%. Clinical manifestations in affected children are non-specific. Currently, there is a lack of large-sample clinical research data in children, and there is no unified standard for the assessment and diagnosis of pediatric pulmonary embolism. This article reviews the recent methods for the recognition and diagnosis of pediatric pulmonary embolism, aiming to provide clinical physicians with guidance for early identification and diagnosis.
文章引用：旷晓莉, 舒畅. 儿童肺血栓栓塞诊断的研究进展[J]. 临床医学进展, 2026, 16(5): 1256-1262. https://doi.org/10.12677/acm.2026.1651926

参考文献

[1] Konstantinides, S.V., Meyer, G., Becattini, C., Bueno, H., Geersing, G., Harjola, V., et al. (2020) 2019 ESC Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism Developed in Collaboration with the European Respiratory Society (ERS). European Heart Journal, 41, 543-603. [Google Scholar] [CrossRef] [PubMed]
[2] Ramiz, S. and Rajpurkar, M. (2018) Pulmonary Embolism in Children. Pediatric Clinics of North America, 65, 495-507. [Google Scholar] [CrossRef] [PubMed]
[3] Heit, J.A. (2015) Epidemiology of Venous Thromboembolism. Nature Reviews Cardiology, 12, 464-474. [Google Scholar] [CrossRef] [PubMed]
[4] Jackson, S.P., Nesbitt, W.S. and Westein, E. (2009) Dynamics of Platelet Thrombus Formation. Journal of Thrombosis and Haemostasis, 7, 17-20. [Google Scholar] [CrossRef] [PubMed]
[5] Essien, E., Rali, P. and Mathai, S.C. (2019) Pulmonary Embolism. Medical Clinics of North America, 103, 549-564. [Google Scholar] [CrossRef] [PubMed]
[6] Tavil, B., Kuskonmaz, B., Kiper, N., Cetin, M., Gumruk, F. and Gurgey, A. (2009) Pulmonary Thromboembolism in Childhood: A Single-Center Experience from Turkey. Heart & Lung, 38, 56-65. [Google Scholar] [CrossRef] [PubMed]
[7] Hangül, M., Köse, M., Pekcan, S., Çalışkan, Ü., Tokgöz, H., Aslan, A.T., et al. (2022) Pulmonary Embolism in Childhood: A Multicenter Experience from Turkey. Balkan Medical Journal, 39, 366-373. [Google Scholar] [CrossRef] [PubMed]
[8] Biss, T.T. (2018) Pulmonary Embolism in Childhood: How Can We Be Sure Not to Miss It? Archives of Disease in Childhood, 103, 814-816. [Google Scholar] [CrossRef] [PubMed]
[9] Carpenter, S.L., Richardson, T. and Hall, M. (2018) Increasing Rate of Pulmonary Embolism Diagnosed in Hospitalized Children in the United States from 2001 to 2014. Blood Advances, 2, 1403-1408. [Google Scholar] [CrossRef] [PubMed]
[10] 宋绍秀, 徐勇胜. 儿童肺炎支原体肺炎合并肺栓塞9例临床分析并文献复习[J]. 山东大学学报(医学版), 2023, 61(11): 96-103.
[11] 陈兰勤, 殷菊, 姚瑶, 等. 儿童中高危肺栓塞临床特征分析[J]. 中华实用儿科临床杂志, 2023, 38(12): 905-909.
[12] 唐晓璐, 杨利新, 徐保平, 等. 儿童肺栓塞的MSCT分析[J]. 医学影像学杂志, 2022, 32(11): 1902-1906.
[13] 戚建晨. 儿童及青年肾病综合征患者肺栓塞形成及复发危险因素的研究及预测[D]: [硕士学位论文]. 镇江: 江苏大学, 2021.
[14] 李贝多, 邵静波. 儿童急性淋巴细胞白血病合并血栓栓塞研究进展[J]. 临床儿科杂志, 2022, 40(6): 475-480.
[15] 闫欣, 张志勇, 罗冲, 等. 儿童系统性红斑狼疮继发抗磷脂综合征及血栓性微血管病1例并文献复习[J]. 中国实用儿科杂志, 2022, 37(4): 293-296.
[16] 周丽, 陆化, 卢瑞南, 等. 以肺栓塞起病的急性淋巴细胞白血病一例[J]. 江苏医药, 2015, 41(5): 601-603.
[17] Wolf, S., Valerio, L., Kucher, N., Konstantinides, S.V., Klaassen, I.L.M., van Ommen, C.H., et al. (2025) Acute Pulmonary Embolism in Children and Adolescents in the USA (2016 and 2019): A Nationwide Retrospective Cohort Study. The Lancet Respiratory Medicine, 13, 393-402. [Google Scholar] [CrossRef] [PubMed]
[18] Rajpurkar, M., Biss, T.T., Amankwah, E.K., Martinez, D., Williams, S., van Ommen, C.H., et al. (2017) Pulmonary Embolism and in Situ Pulmonary Artery Thrombosis in Paediatrics: A Systematic Review. Thrombosis and Haemostasis, 117, 1199-1207. [Google Scholar] [CrossRef] [PubMed]
[19] Stein, P.D., Kayali, F. and Olson, R.E. (2004) Incidence of Venous Thromboembolism in Infants and Children: Data from the National Hospital Discharge Survey. The Journal of Pediatrics, 145, 563-565. [Google Scholar] [CrossRef] [PubMed]
[20] Anderson, D., Rodger, M., Ginsberg, J., Kearon, C., Gent, M., Turpie, A., et al. (2000) Derivation of a Simple Clinical Model to Categorize Patients Probability of Pulmonary Embolism: Increasing the Models Utility with the Simplired D-dimer. Thrombosis and Haemostasis, 83, 416-420. [Google Scholar] [CrossRef] 
[21] Lee, E.Y., Tse, S.K.S., Zurakowski, D., Johnson, V.M., Lee, N.J., Tracy, D.A., et al. (2012) Children Suspected of Having Pulmonary Embolism: Multidetector CT Pulmonary Angiography—Thromboembolic Risk Factors and Implications for Appropriate Use. Radiology, 262, 242-251. [Google Scholar] [CrossRef] [PubMed]
[22] Hennelly, K.E., Baskin, M.N., Monuteuax, M.C., Hudgins, J., Kua, E., Commeree, A., et al. (2016) Detection of Pulmonary Embolism in High-Risk Children. The Journal of Pediatrics, 178, 214-218.e3. [Google Scholar] [CrossRef] [PubMed]
[23] Gok, M. and Kurtul, A. (2021) A Novel Marker for Predicting Severity of Acute Pulmonary Embolism: Systemic Immune-Inflammation Index. Scandinavian Cardiovascular Journal, 55, 91-96. [Google Scholar] [CrossRef] [PubMed]
[24] Ross, C., Kumar, R., Pelland-Marcotte, M., Mehta, S., Kleinman, M.E., Thiagarajan, R.R., et al. (2022) Acute Management of High-Risk and Intermediate-Risk Pulmonary Embolism in Children. Chest, 161, 791-802. [Google Scholar] [CrossRef] [PubMed]
[25] 李春玉, 薛启婷, 李跃. 急性肺栓塞患者肌钙蛋白i、半胱氨酸蛋白酶抑制剂c及肌酸激酶同工酶的表达及临床意义[J]. 实用医院临床杂志, 2023, 20(6): 92-95.
[26] 张春梅, 李丽, 和瑾, 等. 血清BNP、cTnI及D-二聚体联合在急性肺栓塞诊断、治疗及预后评估中的价值[J]. 中国现代药物应用, 2026, 20(8): 18-21.
[27] 郑纯彬. 研究肺动脉栓塞的影像学诊断及方法[J]. 影像研究与医学应用, 2020, 4(13): 57-58.
[28] 赵德育, 张佳敏. 儿童肺血管栓塞性疾病[J]. 中国实用儿科杂志, 2020, 35(9): 693-699.
[29] 郭宵峰. 肺v/q平面显像、肺灌注SPECT/CT及CTPA对肺栓塞临床诊断的对比性研究[D]: [硕士学位论文]. 太原: 山西医科大学, 2015.
[30] 安秀香, 郭佳, 张国旭. 肺V/QSPECT/CT显像对肺栓塞诊断价值研究[J]. 临床军医杂志, 2019, 47(6): 570-572.
[31] 贾春阳, 杨凯华, 孙利芳. 儿童肺炎相关性肺栓塞的临床、CT及CTPA特点[J]. 中国中西医结合影像学杂志, 2023, 21(3): 324-326, 330.
[32] 沈剑斌, 张新誉, 孙亚鹏, 等. CT肺动脉造影联合DSA检查对急性肺栓塞患者短期预后的预测价值[J]. 医学影像学杂志, 2026, 36(1): 60-65.
[33] 郑敏文. 肺栓塞的影像学诊断认识及策略[J]. 诊断学理论与实践, 2019, 18(1): 21-27.
[34] Köse, N., Yıldırım, T., Akın, F., Yıldırım, S.E. and Altun, İ. (2019) Prognostic Role of NLR, PLR, and LMR in Patients with Pulmonary Embolism. Bosnian Journal of Basic Medical Sciences, 20, 248-253. [Google Scholar] [CrossRef] [PubMed]
[35] 张慧芳, 郭奋凯, 陈娟霞, 等. sPESI联合RDW、NLR、MLR对非高危急性肺栓塞患者早期风险的预测价值[J]. 宁夏医科大学学报, 2024, 46(8): 814-818.
[36] 王震. SIRI、AISI和SII对急性肺栓塞的诊断和危险分层的预测价值[J]. 解放军医学院学报, 2024, 45(1): 53-58, 66.
[37] 王震, 白佳玉, 李澎, 等. SIRI、AISI和SII对急性肺栓塞的诊断和危险分层的预测价值[J]. 解放军医学院学报, 2024, 45(1): 53-58, 66.
[38] Liu, T., Kang, J. and Liu, F. (2018) Plasma Levels of MicroRNA-221 (miR-221) Are Increased in Patients with Acute Pulmonary Embolism. Medical Science Monitor, 24, 8621-8626. [Google Scholar] [CrossRef] [PubMed]
[39] Liu, Y., Xie, M., Gao, X. and Liu, R. (2021) Predictive Value of Circulating MicroRNA-134 Levels for Early Diagnosis of Acute Pulmonary Embolism: Meta-Analysis. Journal of Cardiovascular Translational Research, 14, 744-753. [Google Scholar] [CrossRef] [PubMed]
[40] 王晓亮, 姚琦, 金钊, 等. 微小RNA-885-3p在早期急性肺栓塞诊断中的临床意义[J]. 中国临床药理学杂志, 2023, 39(10): 1407-1411.

为你推荐