Cholesterol embolism: Still an unrecognized entity with a high mortality rate
Cholesterol embolism: Still an unrecognized entity with a high mortality rate
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DOI：
10.1016/j.jaad.2006.05.012
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发表时间：
2006-11-01
影响因子：
13.8
通讯作者：
Vidaller, Antonio
中科院分区：
文献类型：
--
作者：
Jucgla, Anna;Moreso, Francesc;Vidaller, Antonio
背景：胆固醇栓塞（CE）是一种越来越常见但常被误诊的医学问题。对CE临床表现的认识是正确诊断的第一步。目的：我们的目的是描述CE的特征和致命结局的危险因素。方法：回顾性分析1993年1月至2003年3月间临床及病理诊断为CE的患者的临床资料。结果：男性患者26例。平均年龄64岁（范围48 ~ 88岁）。所有患者都有两种或两种以上的动脉粥样硬化危险因素。除了一名患者外，所有患者都有先前存在的症状性动脉粥样硬化疾病。23例患者（88%）至少有一个诱发因素。入院时诊断为CE的患者仅有9例（35%）。皮肤病变（88%）和肾功能衰竭（73%）是最常见的临床表现。21例患者（81%）出现并发症（透析、急性肺水肿、截肢或胃肠手术），15例患者死亡（58%）。既往慢性肾衰竭是唯一与死亡率相关的变量（相对危险度：4.54,95%可信区间1.26-16.6;P = 0.02）。局限性：研究结果来自一所大学医院的住院患者。这一事实可能选择了更高比例的严重病例。结论：CE易误诊。皮肤病变是最常见的临床表现，大多数患者的皮肤活检提供了组织学证实。慢性肾衰竭是唯一与死亡相关的因素。
Background: Cholesterol embolism (CE) is an increasingly common but often underdiagnosed medical problem. The recognition of clinical manifestations of CE is the first step toward a correct diagnosis.Objective: Our aim was to characterize the features of CE and the risk factors for fatal outcome.Methods: Clinical records of patients with clinical and histopathologic diagnoses of CE seen from January 1993 through March 2003 were reviewed.Results: Twenty-six male patients were identified. Mean age was 64 years (range, 48-88 years). All patients had two or more risk factors for atherosclerosis. All but one patient had preexisting symptomatic atherosclerotic disease. At least one precipitating factor was identified in 23 patients (88%). Diagnosis of CE at admission was made in 9 patients only (35%). Cutaneous lesions (88%) and renal failure (73%) were the most common clinical findings. Complications (dialysis, acute pulmonary edema, amputation, or gastrointestinal surgery) were present in 21 patients (81%), and 15 patients died (58%). Previous chronic renal failure was the only variable associated with mortality (relative risk: 4.54, 95% confidence interval 1.26-16.6; P =.02).Limitations: The results were obtained from patients admitted to a university hospital. This fact may have selected a higher proportion of severe cases.Conclusions: CE was frequently misdiagnosed. Skin lesions were the most common clinical findings and skin biopsy provided histologic confirmation in most of the patients. Chronic renal failure was the only factor related to death.