急性肺栓塞的诊断研究进展

Research Progress in Diagnosis of Acute Pulmonary Embolism

摘要: 急性肺血栓栓塞症(APE)患者的危险因素较多，临床症状和体征缺乏特异性。纵向研究表明，肺栓塞的年发病率有上升趋势，有数据显示，在美国，肺栓塞在心血管死亡原因中位居前列，欧洲、亚洲和北美人群的时间趋势分析表明，急性肺栓塞过去几十年存在发病率上升及病死率下降的趋势，计算机断层肺血管造影有助于及时诊断也有利于更快地进行治疗及干预措施。但这似乎往往会导致过度测试和过度诊断急性肺栓塞的不良影响，即电离辐射和诱发癌症、碘造影剂的肾毒性、临床无关PE抗凝导致的出血以及财务成本，为防止过度诊断，熟悉肺栓塞的临床诊断及有效进行评估分层，能避免造成不良后果。就近年急性肺栓塞的诊断研究进展进行综述，以期为急性肺栓塞的诊断提供建议及依据。

Abstract: There are many risk factors in patients with acute pulmonary thromboembolism (APE), and the clinical symptoms and signs lack specificity. Longitudinal studies have shown that the annual inci-dence of pulmonary embolism has an upward trend. Some data show that pulmonary embolism is the leading cause of cardiovascular death in the United States. Time-trend analysis of European, Asian, and North American populations shows that acute pulmonary embolism has increased in in-cidence and decreased in mortality over the past few decades. Computer tomography pulmonary angiography is helpful for timely diagnosis and faster treatment and intervention. However, this of-ten seems to lead to the adverse effects of over-testing and over-diagnosis of acute pulmonary em-bolism, namely, ionizing radiation and induction of cancer, nephrotoxicity of iodine contrast agents, bleeding caused by clinically unrelated PE anticoagulation, and financial costs. In order to prevent over-diagnosis, being familiar with the clinical diagnosis of pulmonary embolism and effective evaluation stratification can avoid adverse consequences. This article reviews the research progress in the diagnosis of acute pulmonary embolism in recent years in order to provide suggestions and a basis for the diagnosis of acute pulmonary embolism.