Splenectomy and chronic thromboembolic pulmonary hypertension
Splenectomy and chronic thromboembolic pulmonary hypertension
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DOI：
10.1136/thx.2004.038083
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发表时间：
2005-12-01
期刊：
影响因子：
10
通讯作者：
Humbert, M
中科院分区：
文献类型：
--
作者：
Ja誰s, X;Ioos, V;Humbert, M
背景：据报道，特发性肺动脉高压患者脾切除术的患病率增加。对这些受试者的小肺动脉检查发现多处血栓性病变，表明血栓形成可能导致这种情况。基于这些发现，我们假设脾切除术可能是慢性血栓栓塞性肺动脉高压（CTEPH）的危险因素，CTEPH是一种急性肺栓塞后血栓未消退的疾病，可导致肺动脉持续阻塞和随后的肺动脉高压。方法：回顾了1989年至1999年期间转诊的257例CTEPH患者的病史、临床特征、血栓形成危险因素和血流动力学。在一项病例对照研究中，将CTEPH患者中脾切除术的患病率与同期评估的特发性肺动脉高压患者（n = 276）或其他慢性肺部疾病中肺移植患者（n = 180）进行了比较。在CTEPH患者中，8.6%（95% CI 5.2 - 12.0）有脾切除术史，结论：脾切除术可能是慢性血栓栓塞性肺动脉高压的危险因素。
Background: An increased prevalence of splenectomy has been reported in patients with idiopathic pulmonary arterial hypertension. Examination of small pulmonary arteries from these subjects has revealed multiple thrombotic lesions, suggesting that thrombosis may contribute to this condition. Based on these findings, we hypothesised that splenectomy could be a risk factor for chronic thromboembolic pulmonary hypertension (CTEPH), a condition defined by the absence of thrombus resolution after acute pulmonary embolism that causes sustained obstruction of the pulmonary arteries and subsequent pulmonary hypertension.Methods: The medical history, clinical characteristics, thrombotic risk factors and haemodynamics of 257 patients referred for CTEPH between 1989 and 1999 were reviewed. In a case- control study the prevalence of splenectomy in patients with CTEPH was compared with that of patients evaluated during the same period for idiopathic pulmonary hypertension (n = 276) or for lung transplantation in other chronic pulmonary conditions (n = 180).Results: In patients with CTEPH, 8.6% (95% CI 5.2 to 12.0) had a history of splenectomy compared with 2.5% ( 95% CI 0.7 to 4.4) and 0.56% ( 95% CI 0 to 1.6) in cases of idiopathic pulmonary arterial hypertension and other chronic pulmonary conditions, respectively (p, 0.01).Conclusion: Splenectomy may be a risk factor for chronic thromboembolic pulmonary hypertension.