慢性血栓栓塞性肺动脉高压和慢性血栓栓塞性肺疾病

黄伸伸; 邱家勇; 毛毅敏

doi:10.12376/j.issn.2097-0501.2023.01.003

慢性血栓栓塞性肺动脉高压和慢性血栓栓塞性肺疾病

doi: 10.12376/j.issn.2097-0501.2023.01.003

黄伸伸¹,
邱家勇^{1, 2},
毛毅敏^1, ,

1.
河南科技大学第一附属医院呼吸与危重症医学科，洛阳 471000
2.
河北医科大学第二医院呼吸与危重症医学科，石家庄 050000

基金项目:

河南省自然科学基金 182300410365

详细信息

通信作者:
毛毅敏，E-mail: 1419295143qq.com

中图分类号: R544.1;R563.5
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- 被引次数: 0
出版历程
- 收稿日期: 2022-12-08
- 修回日期: 2022-12-31
- 网络出版日期: 2023-03-07

Chronic Thromboembolic Pulmonary Hypertension and ChronicThromboembolic Pulmonary Disease

HUANG Shenshen¹,
QIU Jiayong^{1, 2},
MAO Yimin^{1
, ,}

1.
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471000, China
2.
Department of Respiratory and Critical Care Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China

Funding:

The Natural Science Foundation of Henan Province 182300410365

More Information

Corresponding author: MAO Yimin, E-mail: 1419295143qq.com

摘要

摘要: 慢性血栓栓塞性肺动脉高压(CTEPH)和慢性血栓栓塞性肺疾病(CTEPD)是急性肺栓塞后因肺动脉内血栓残留、机化，伴或不伴肺动脉高压(PH)的一类疾病。随着诊疗的不断进步、综合治疗策略的观念更新，使这类疾病的预后得到极大改善。但医务人员对这类疾病认识不足，且中国缺少流行病学数据，发病机制未明，具有非特异性临床表现。因此，在临床上易误诊、漏诊和延迟诊断。为了加强医务工作者对其认识，本文对CTEPH和CTEPD的定义、流行病学、病理、发病机制、诊断和治疗等方面予以归纳总结。
- 慢性血栓栓塞性肺动脉高压 /
- 慢性血栓栓塞性肺疾病 /
- 肺血栓栓塞症
Abstract: Chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease (CTEPD) are diseases that occur after acute pulmonary embolism resulting from residual and organized intra-pulmonary thrombus, with or without pulmonary hypertension(PH). The prognosis of these diseases has been dramatically improved with the continuous progress of treatment and the updated concept of the comprehensive treatment strategy. However, there is a lack of awareness of these diseases among medical practitioners, and a lack of epidemiological data in China, with unknown pathogenesis and non-specific clinical manifestations. Therefore, it is easy to misdiagnosis, underdiagnosis and delay diagnosis in clinical practice. To enhance the understanding of medical personnel, this paper summarizes the definition, epidemiology, pathology, pathogenesis, diagnosis and treatment of CTEPH and CTEPD.
- chronic thromboembolic pulmonary hypertension /
- chronic thromboembolic pulmonary disease /
- pulmonary thromboembolism
注释:

作者贡献：黄伸伸、邱家勇负责综述文献检索、分析和论文撰写；毛毅敏负责论文选题、分析、润色和修改。

利益冲突：所有作者均声明不存在利益冲突。

HTML全文

图 1 疑诊肺动脉高压的诊断策略

^a警告信号包括症状进展迅速、运动耐量严重减弱、轻度运动时出现晕厥前症状或晕厥、右心衰竭的迹象；^bCTEPH危险因素：PTE病史、永久性血管内装置、炎症性肠病、原发性血小板增多症、脾切除术、大剂量甲状腺激素替代疗法及恶性肿瘤；PH：肺动脉高压；PAH：动脉型肺动脉高压；NT-proBNP：N端脑钠肽前体；CTEPH：慢性血栓栓塞性肺动脉高压；CTPA：CT肺动脉造影

Figure 1. Diagnostic strategy of suspected pulmonary hypertension (PH)

下载: 全尺寸图片幻灯片

图 2 肺血栓栓塞症(PTE)后慢性血栓栓塞性肺疾病(CTEPD)和慢性血栓栓塞性肺动脉高压(CTEPH)的诊断策略

V/Q：核素肺灌注显像；RHC：静息状态下右心导管检查

Figure 2. Diagnostic strategies of chronic thrombo-embolic pulmonary disease(CTEPD) and chronic thromboembolic pulmonary hypertension(CTEPH) after pulmonary thromboembolism(PTE)

下载: 全尺寸图片幻灯片

图 3 Leiden CTEPH排除流程

右心室压力过载的心电图标准: 1.V1导联rSR′或rSr′; 2.V1导联R∶S＞1，伴有R＞0.5 mV; 3.QRS轴＞90 °

Figure 3. Leiden CTEPH exclusion process

下载: 全尺寸图片幻灯片

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