摘要目的 探讨老年人急性肺栓塞患者临床表现和危险因素的差异. 方法 将141例经CT肺动脉造影(CTPA)或直接肺动脉造影或放射性核素肺灌注显像结合临床资料确诊的急性肺栓塞患者按年龄分为老年组78例和非老年组63例,比较两组临床表现和危险因素的差异,并选取同时段在我院进行常规体检的100例为对照组,采用多元Logistic回归模型分析老年人急性肺栓塞危险因素. 结果 老年组和非老年组呼吸困难、咳嗽、胸闷、胸痛的患病率分别为88.5％ (69例)与84.1％(53例)、76.9％(60例)与69.8％(44例)、56.4％(44例)与63.5％(40例)、15.4％(12例)与25.4％(16例),两组比较差异无统计学意义(均为P＞0.05),但老年组咯血的患病率9.0％(7例),低于非老年组23.8％(15例)(P＜0.05),老年组无症状患者9.0％(7例)比非老年组1.6％(1例)多,但差异无统计学意义(P＞0.05)；老年组的危险因素多见于糖尿病(x2 =7.41,P＜0.01)、高血压(x2=14.51,P＜0.01)、慢性阻塞性肺疾病(COPD)(x2=7.42,P＜0.01)和既往脑卒中(x2=4.91,P＜0.05),老年组的独立危险因素分别为COPD(OR:3.29,95％CI:1.04～10.46)、既往深静脉血栓史(OR:4.72,95％CI:1.68～13.27)、恶性肿瘤(OR:4.35,95％CI:1.00～18.13,)和既往脑卒中(OR:5.13,95％CI:1.15～24.52)；非老年组为既往深静脉血栓史(OR:11.94,95％CI:3.35～42.60)和恶性肿瘤(OR∶11.44,95％CI:1.44～89.92). 结论 老年急性肺栓塞患者的临床表现与非老年组相似,多不典型,虽然呼吸困难仍为最常见的临床表现,但不明原因的咳嗽和胸闷应警惕；COPD、恶性肿瘤、既往深静脉血栓和脑卒中史均为老年人急性肺栓塞的独立危险因素,需注意加以鉴别.

abstractsObjective To investigate the differences in clinical symptoms and risk factors between non-elderly and elderly patients with acute pulmonary thromboembolism(PTE).Methods Totally141 patients with acute PTE and 100 sex and age-matched healthy controls were enrolled in the study.The final diagnosis was confirmed by CT pulmonary angiography (CTPA) and/or pulmonary angiography and/or pulmonary perfusion imaging as well as medical history.The patients with acute PTE were divided into two groups according age:elderly group (n=78,age≥60 years),young group (n =63,age ＜ 60 years).Multivariate Logistic regression analysis was performed to identify independent risk factors of PTE and to confirm the risk of each factor.Results The morbidity rate of dyspnea,cough,chest distress and chest pain were 88.5％ (69 cases),76.9％ (60 cases),56.4％ (44 cases),15.4％ (12 cases) in elderly group,which was similar to 84.1％ (53 cases),69.8％ (44 cases),63.5％ (40 cases),25.4％ (16 cases) in young group (all P＞0.05)； while the morbidity rate of hemoptysis in elderly group [9.0％ (7 cases)] was lower than in young group [23.8％(15 cases)](P＜0.05).9％ (7 cases) in elderly patients without any symptoms were more than 1.6％ (1 cases) in young patients,but no significant differene (P＞0.05).There were more risk factors in the elderly group accompanying with diabetes (x2 =7.41,P ＜ 0.01),hypertension (x2 =14.51,P＜ 0.01),chronic obstructive pulmonary diseases (COPD) (x2 =7.42,P＜0.01) and previous stroke (x2 =4.91,P＜0.05)compared with young group.Independent risk factors for elderly acute PTE included COPD (OR:3.29,95％CI:1.04-10.46),previous deep veneus thrombosis(DVT) (OR:4.72,95％CI:1.68-13.27),cancers (OR:4.35,95％CI:1.00-18.13) and previous stroke (OR:5.13,95％CI:1.15-24.52).Independent risk factors for non-elderly PTE included previous DVT (OR:11.94,95％ CI:3.35-42.60)and cancers (OR:11.44,95％CI:1.44-89.92).Conclusions Much attention should be paid to the identification of diagnosis of acute PTE depending on the non-specific clinical features,although dyspnea may be the most frequency symptoms,but unexplained cough and chest distress should be alert for PTE.COPD,cancer,DVT and previous stroke are independent and important risk factors for elderly acute PTE.