A prospective investigation of pulmonary embolism in women and men.
A prospective investigation of pulmonary embolism in women and men.
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DOI：
10.1001/jama.1992.03490130077034
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发表时间：
1992-10
期刊：
影响因子：
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通讯作者：
Deborah A. Quinn;B. Thompson;Michael L. Terrin;James H. Thrall;Christos A. Athanasoulis;K. Mckusick;P. D. Stein;Charles A. Hales
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文献类型：
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作者：
Deborah A. Quinn;B. Thompson;Michael L. Terrin;James H. Thrall;Christos A. Athanasoulis;K. Mckusick;P. D. Stein;Charles A. Hales
本研究的目的是比较疑似肺栓塞的女性和男性，肺栓塞的频率、危险因素、诊断和表现，以及通气/灌注扫描（V/Q扫描）作为诊断工具的准确性。设计在前瞻性研究（肺栓塞诊断的前瞻性调查）中收集数据，以确定V/Q扫描与肺血管造影的准确性。在马萨诸塞州、密歇根州、康涅狄格州、宾夕法尼亚州和北卡罗来纳州设有六个三级医疗中心。参与者：疑似肺栓塞且要求进行V/Q扫描或肺血管造影的患者（496名女性和406名男性）。结果50岁及以下女性的肺栓塞发生率较同龄男性降低（16% vs 32%），但50岁以上患者无差异（Breslow-Day检验，P < 0.01）。肺栓塞的危险因素、V/Q扫描的有效性和1年死亡率在男女之间没有差异。女性使用雌激素与肺栓塞频率增加无关，使用口服避孕药且在3个月内接受过手术的女性除外；5例中有4例（80%）有栓塞，而28例年龄匹配的未使用雌激素的手术患者中有4例（14%）有栓塞（P < 0.01）。结论在肺栓塞诊断前瞻性调查研究中，年龄在50岁及以下的疑似肺栓塞的女性（甚至是服用口服避孕药的年轻女性）发生肺栓塞的频率低于同年龄的男性，发生肺栓塞的危险因素男女相同，但服用口服避孕药的女性术后发生肺栓塞的风险增加。虽然V/Q扫描在这些女性肺栓塞的初步评估中是一个有用的工具，但为了准确诊断，通常需要肺血管造影。
OBJECTIVE The aim of this study was to compare, in women and men suspected of pulmonary embolism, the frequency, risk factors, diagnosis, and presentation of pulmonary embolism as well as the accuracy of the ventilation/perfusion scan (V/Q scan) as a diagnostic tool. DESIGN Data were collected during a prospective study (the Prospective Investigation of Pulmonary Embolism Diagnosis) to establish the accuracy of the V/Q scan compared with pulmonary angiograms. SETTING Six tertiary medical centers in Massachusetts, Michigan, Connecticut, Pennsylvania, and North Carolina. PARTICIPANTS Patients suspected of pulmonary embolism for whom a request was made for a V/Q scan or pulmonary angiogram (496 women and 406 men). RESULTS Women 50 years old and under had a decreased frequency of pulmonary embolism compared with men of that age (16% vs 32%), but there was no difference in patients over 50 years old (Breslow-Day test, P less than .01). Risk factors for pulmonary embolism, the usefulness of the V/Q scan, and 1-year mortality were not different for women and men. Estrogen use in women was not associated with an increased frequency of pulmonary embolism, except in women using oral contraceptives who had undergone surgery within 3 months; four of five (80%) had emboli compared with four of 28 (14%) age-matched surgical patients not using estrogens (P less than .01). CONCLUSION Women 50 years old and under (even young women using oral contraceptives) who were suspected of having pulmonary emboli and were enrolled in the Prospective Investigation of Pulmonary Embolism Diagnosis study had a smaller frequency of pulmonary embolism than men of that age, The risk factors for pulmonary embolism were the same for women and men, except that women using oral contraceptives had an increased risk of pulmonary embolism following surgery. Although the V/Q scan was a useful tool in the preliminary evaluation for pulmonary embolism in these women, a pulmonary angiogram was often needed for accurate diagnosis.