Revista clinica espanola最新文献_第4页

Clinical features, management in the emergency department and mortality of acute heart failure episodes in patients with chronic obstructive pulmonary disease 慢性阻塞性肺病患者急性心力衰竭发作的临床特征、急诊科处理和死亡率。

Revista clinica espanola

Pub Date : 2024-12-01 DOI: 10.1016/j.rceng.2024.10.003

N. Ivars , Pere Llorens , A. Alquézar , J. Jacob , B. Rodríguez , M. Guzmán , L. Serrano Lázaro , M.C. Martínez Picón , L. Cuevas Jiménez , Ò. Miró , on behalf of ICA SEMES research group

Objectives

This study aims to analyse differences in clinical and therapeutic management for patients with chronic obstructive pulmonary disease (COPD) who present to the emergency department with acute heart failure (AHF). Additionally, it examines mortality rates during such episodes.

Methods

We included patients diagnosed with AHF at 50 Spanish emergency departments from 2012 to 2022 who also had COPD. We compared their baseline characteristics, decompensation episodes, and emergency department management with those of AHF patients without COPD during the same period. We collected data on in-hospital and 30-day all-cause mortality, investigating differences between the two groups using crude and adjusted logistic regression models.

Results

A total of 21,694 AHF patients were analysed (median age = 83 years, 56% female), including 4,942 (23%) with COPD. COPD patients were generally younger and more frequently male, with a higher prevalence of comorbidities (excluding valve disease and dementia, which were more common in non-COPD patients). They exhibited a worse respiratory functional class (NYHA) but a better overall functional capacity (Barthel Index). Decompensation in COPD patients was more often triggered by infection and less frequently by tachyarrhythmia, hypertensive crisis, or acute coronary syndrome. While there were differences in clinical findings in the emergency department, the severity assessed by the MEESSI-AHF Scale was similar across both groups. In terms of emergency department management, a higher proportion of COPD patients received oxygen therapy, non-invasive ventilation, bronchodilators, corticosteroids, and antibiotics, while fewer received intravenous nitroglycerin, and they were hospitalized more frequently. In-hospital mortality rates were 8.1% for patients with COPD and 7.5% for those without (OR = 1.088, 95% CI = 0.968–1.224), with 30-day mortality rates of 11.0% and 10.0%, respectively (OR = 1.111, 95% CI = 1.002–1.231). After adjusting for clinical characteristics, decompensation episodes, and emergency department management, these odds ratios decreased to 1.040 (95% CI = 0.905–1.195) and 1.080 (95% CI = 0.957–1.219), respectively.

Conclusion

Patients with AHF and COPD exhibit distinct clinical and therapeutic management characteristics in the emergency department and require more frequent hospitalization. Although they show higher crude 30-day mortality, this is attributable to their differing clinical profiles rather than the presence of COPD itself.

研究目的本研究旨在分析因急性心力衰竭（AHF）而到急诊科就诊的慢性阻塞性肺病（COPD）患者在临床和治疗管理方面的差异。此外，该研究还探讨了此类病例的死亡率：我们纳入了 2012 年至 2022 年期间在西班牙 50 个急诊科确诊为急性心力衰竭且同时患有慢性阻塞性肺病的患者。我们将他们的基线特征、失代偿发作和急诊科处理情况与同期无慢性阻塞性肺病的 AHF 患者进行了比较。我们收集了院内死亡率和 30 天全因死亡率的数据，并使用粗略和调整后的逻辑回归模型研究了两组患者之间的差异：共分析了 21,694 名 AHF 患者（中位年龄 = 83 岁，56% 为女性），其中包括 4,942 名 COPD 患者（23%）。慢性阻塞性肺病患者通常更年轻，男性更多，合并症发病率更高（不包括瓣膜病和痴呆症，这在非慢性阻塞性肺病患者中更为常见）。他们的呼吸功能分级（NYHA）较差，但总体功能能力（Barthel 指数）较好。慢性阻塞性肺病患者的机能减退更多是由感染引起的，而较少由快速性心律失常、高血压危象或急性冠状动脉综合征引起。虽然两组患者在急诊科的临床表现存在差异，但通过 MEESSI-AHF 量表评估的严重程度相似。在急诊科处理方面，接受氧疗、无创通气、支气管扩张剂、皮质类固醇和抗生素治疗的慢性阻塞性肺病患者比例更高，而接受硝酸甘油静脉注射的患者比例更低，而且住院治疗的频率更高。慢性阻塞性肺病患者的院内死亡率为8.1%，非慢性阻塞性肺病患者的院内死亡率为7.5%（OR = 1.088，95% CI = 0.968-1.224），30天死亡率分别为11.0%和10.0%（OR = 1.111，95% CI = 1.002-1.231）。在对临床特征、失代偿发作和急诊科处理进行调整后，这些几率比分别降至1.040（95% CI = 0.905-1.195）和1.080（95% CI = 0.957-1.219）：结论：AHF 和 COPD 患者在急诊科表现出不同的临床和治疗特点，需要更频繁的住院治疗。虽然他们的 30 天粗死亡率较高，但这归因于他们不同的临床特征，而非慢性阻塞性肺病本身。

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引用次数: 0

Association between autoimmune diseases and Alzheimer’s disease: analysis using big data tools 自身免疫性疾病与阿尔茨海默病之间的关联：利用大数据工具进行分析。

Revista clinica espanola

Pub Date : 2024-12-01 DOI: 10.1016/j.rceng.2024.09.003

A.M. Diezma-Martín , M.I. Morales-Casado , L. Jiménez-Díaz , J.D. Navarro-López , B. Mondéjar-Marín , J. Parra-Serrano , A. Vadillo-Bermejo , C. Marsal-Alonso , P. Beneyto-Martín

Objective

The objective is to analyze the prevalence of Alzheimer's disease in patients with and without a diagnosis of different autoimmune diseases and the possible association between both pathologies.

Patients and methods

A multicenter, retrospective, cohort study was conducted to study the prevalence of Alzheimer’s disease among patients diagnosed with various autoimmune diseases compared to the general population. Data from electronic medical records from the Castilla-La Mancha healthcare system were analyzed using Natural Language Processing through the Savana Manager® artificial intelligence clinical platform. A total of 1,028,356 patients were analyzed, including 28,920 individuals with Alzheimer's disease and 999,436 control patients.

Results

Out of the 12 autoimmune diseases analyzed, 5 showed a significant association with Alzheimer's disease with p < 0.05. Myasthenia gravis had an increased prevalence of AD with OR 1.49 (95% CI 1.11–2), systemic lupus erythematosus with OR 2.42 (95% CI 2.02–2.88), rheumatoid arthritis with OR 1.38 (95% CI 1.24–1.54), polymyalgia rheumatica with OR 2.01 (95% CI 1.08–2.23), and pernicious anemia with OR 2.06 (95% CI 1.59–2.66). The remaining autoimmune diseases analyzed did not show a higher prevalence of Alzheimer's disease compared to the general population.

Conclusions

There may be an association between certain systemic autoimmune diseases and Alzheimer's disease. Further studies are needed to confirm our findings, establish causality, and explore the underlying mechanisms of this association.

研究目的目的是分析阿尔茨海默病在确诊患有和未确诊患有不同自身免疫性疾病的患者中的患病率，以及这两种病症之间可能存在的关联：我们开展了一项多中心、回顾性、队列研究，以研究与普通人群相比，阿尔茨海默病在确诊患有各种自身免疫性疾病的患者中的患病率。研究人员通过 Savana Manager® 人工智能临床平台，使用自然语言处理技术对卡斯蒂利亚-拉曼恰医疗系统电子病历中的数据进行了分析。共分析了1,028,356名患者，包括28,920名阿尔茨海默氏症患者和999,436名对照组患者：结果：在分析的 12 种自身免疫性疾病中，有 5 种与阿尔茨海默氏症有显著关联（p 结论：某些自身免疫性疾病可能与阿尔茨海默氏症有关联：某些系统性自身免疫疾病与阿尔茨海默病之间可能存在关联。我们需要进一步研究来证实我们的发现、确定因果关系并探索这种关联的内在机制。

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引用次数: 0

Anemia of inflammation and iron metabolism in chronic diseases 慢性疾病中的炎症性贫血和铁代谢。

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rceng.2024.09.002

S. Conde Díez , R. de las Cuevas Allende , E. Conde García

Anemia of Inflammation begins with the activation of the immune system and the subsequent release of cytokines that lead to an elevation of hepcidin, responsible for hypoferremia, and a suppression of erythropoiesis due to lack of iron. The anemia is usually mild/moderate, normocytic/normochromic and is the most prevalent, after iron deficiency anemia, and is the most common in patients with chronic diseases, in the elderly and in hospitalized patients. Anemia can influence the patient’s quality of life and have a negative impact on survival. Treatment should be aimed at improving the underlying disease and correcting the anemia. Intravenous iron, erythropoietin and prolyl hydroxylase inhibitors are the current basis of treatment, but future therapy is directed against hepcidin, which is ultimately responsible for anemia.

炎症性贫血的起因是免疫系统被激活，细胞因子随之释放，导致血色素升高，造成低铁蛋白血症，并因缺铁而抑制红细胞生成。贫血通常为轻度/中度、正常红细胞/正常虹膜色素沉着，是继缺铁性贫血之后发病率最高的一种贫血，在慢性病患者、老年人和住院病人中最为常见。贫血会影响患者的生活质量，并对生存产生负面影响。治疗的目的应是改善基础疾病，纠正贫血。静脉注射铁剂、促红细胞生成素和脯氨酰羟化酶抑制剂是目前治疗的基础，但未来的治疗将针对血红素，因为血红素是造成贫血的最终原因。

引用次数: 0

Clinical perspective of anti-HMGCR immune-mediated necrotizing myopathy: analysis of three cases 抗 HMGCR 免疫介导的坏死性肌病的临床视角：三例病例分析。

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rceng.2024.08.005

J.P. de la Fuente Peñaloza , L. Quintana Cabezas , M.C. Yubini Lagos

引用次数: 0

Soluble receptor for advanced glycation end-products positively correlated to kidney injury with coronary heart disease 高级糖化终产物可溶性受体与冠心病肾损伤呈正相关。

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rceng.2024.08.001

Lu Chen , Xiang-Jun Zeng , Xin-Ying Guo , Jian Liu , Feng-He Du , Cai-Xia Guo

Aims

Coronary heart disease (CHD) patients with changed serum soluble receptor for advanced glycation end products (sRAGE) will experience microalbuminuria and even kidney dysfunction. However, the role of sRAGE for microalbuminuria in CHD is still not established. This study aimed to evaluate the association between sRAGE and early kidney dysfunction in CHD patients.

Materials and methods

In this cross-sectional study, sRAGE and urinary albumin-to-creatinine ratio (uACR) were measured in hospitalized CHD patients who have undergone coronary arteriography to evaluate the distinction and correlation between sRAGE and uACR.

Results

There were 127 CHD patients (mean age: 63.06 ± 10.93 years, 93 males) in the study, whose sRAGE were 1.83 ± 0.64 μg/L. The sRAGE level was higher in kidney injury group (uACR ≥ 30 mg/g) compared with no kidney injury group (uACR < 30 mg/g) [(2.08 ± 0.70 vs. 1.75 ± 0.61) μg/L, P < 0.05]. Moreover, the positive correlation between serum sRAGE and uACR was significant in CHD patients (r = 0.196, P < 0.05). Binary logistic regression suggests sRAGE as a predictor for microalbuminuria in CHD patients [Odd Ratio = 2.62 (1.12–6.15), P < 0.05)]. The area under the receiver operating characteristic curve (AUC) of sRAGE is higher than that of the traditional indicators of renal function such as creatinine and estimated glomerular filtration rate, indicating sRAGE might have a good performance in evaluating early kidney injury in CHD patients [AUC is 0.660 (0.543–0.778), P < 0.01)].

Conclusions

Serum sRAGE was positively correlated to uACR and might serve as a potential marker to predict early kidney injury in CHD patients.

目的：血清可溶性高级糖化终产物受体（sRAGE）发生变化的冠心病（CHD）患者会出现微量白蛋白尿，甚至肾功能障碍。然而，sRAGE 在冠心病微量白蛋白尿中的作用仍未确定。本研究旨在评估 sRAGE 与 CHD 患者早期肾功能障碍之间的关系：在这项横断面研究中，对接受冠状动脉造影术的住院 CHD 患者进行了 sRAGE 和尿白蛋白与肌酐比值（uACR）的测量，以评估 sRAGE 和 uACR 之间的区别和相关性：研究共涉及 127 名冠心病患者（平均年龄：63.06±10.93 岁，男性 93 人），其 sRAGE 为 1.83±0.64 μg/L。与无肾损伤组（uACR 结论）相比，肾损伤组（uACR ≥ 30 mg/g）的 sRAGE 水平更高：血清 sRAGE 与 uACR 呈正相关，可作为预测心脏病患者早期肾损伤的潜在标志物。

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引用次数: 0

Strategic framework for the Spanish Society of Internal Medicine. 2025-2029. Executive summary on guaranteeing person-centered care in a high value National Health System 西班牙内科学会 2025-2029 年战略框架执行摘要，以确保在高价值的国家卫生系统中提供适合个人的医疗服务。

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rceng.2024.09.005

J. Carretero Gómez , M.M. Chimeno Viñas , J.M. Porcel Pérez , M. Méndez Bailón , P. Pérez Martínez , M.T. Herranz Marín , F.J. Elola Somoza , en nombre de los miembros de los comités para el proceso de reflexión estratégica de laSEMI

Aims

To design a strategic framework for the policy and activity of the Spanish Society of Internal Medicine (SEMI).

Methods

Expert consensus. Participation through expert committees and consultation of internists on the proposed strategic lines.

Results

The SEMI's motto was changed to “comprehensive care for patients.” Seven strategic lines were defined: Contribute to the transformation of the health system; participate in university teaching; guarantee comprehensive healthcare for patients; provide internal medicine residents and internists with the skills to practice in 21st century healthcare; promote research and the generation of scientific evidence in internal medicine; incorporate technological innovation and digital tools; position the SEMI as a model institution for healthcare policy.

Conclusions

SEMI seeks to be a key player in the transformation of the Spanish healthcare system.

目的：为西班牙内科学会（SEMI）的政策和活动设计一个战略框架：方法：专家共识。结果：西班牙内科学会的口号改为 "为病人提供全面护理"：结果：西班牙内科学会的口号改为 "为病人提供全面护理"，并确定了七项战略方针：结果：SEMI的口号改为 "为病人提供全面的医疗服务"，并确定了七项战略方针：促进医疗系统的改革；参与大学教学；保证为病人提供全面的医疗服务；为内科住院医师和内科医生提供在21世纪医疗服务中执业的能力；促进内科研究和科学证据的产生；结合技术创新和数字工具；将SEMI定位为医疗政策的参考机构：结论：西班牙医学科学院建议成为西班牙医疗保健系统转型的关键参与者。

{"title":"Strategic framework for the Spanish Society of Internal Medicine. 2025-2029. Executive summary on guaranteeing person-centered care in a high value National Health System","authors":"J. Carretero Gómez , M.M. Chimeno Viñas , J.M. Porcel Pérez , M. Méndez Bailón , P. Pérez Martínez , M.T. Herranz Marín , F.J. Elola Somoza , en nombre de los miembros de los comités para el proceso de reflexión estratégica de laSEMI","doi":"10.1016/j.rceng.2024.09.005","DOIUrl":"10.1016/j.rceng.2024.09.005","url":null,"abstract":"<div><h3>Aims</h3><div>To design a strategic framework for the policy and activity of the Spanish Society of Internal Medicine (SEMI).</div></div><div><h3>Methods</h3><div>Expert consensus. Participation through expert committees and consultation of internists on the proposed strategic lines.</div></div><div><h3>Results</h3><div>The SEMI's motto was changed to “comprehensive care for patients.” Seven strategic lines were defined: Contribute to the transformation of the health system; participate in university teaching; guarantee comprehensive healthcare for patients; provide internal medicine residents and internists with the skills to practice in 21st century healthcare; promote research and the generation of scientific evidence in internal medicine; incorporate technological innovation and digital tools; position the SEMI as a model institution for healthcare policy.</div></div><div><h3>Conclusions</h3><div>SEMI seeks to be a key player in the transformation of the Spanish healthcare system.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 609-622"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Delayed diagnosis and missed opportunities in the early detection of atrial fibrillation: a cross-sectional study 心房颤动早期检测中的延迟诊断和错失良机：一项横断面研究。

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rceng.2024.08.002

F. Richard Espiga , M. Almendro Delia , F. Caballero Martínez , D. Monge Martín , F. Neria Serrano , R. Quirós López

Introduction

We analysed the frequency of atrial fibrillation (AF) delayed diagnosis and the factors associated with it in newly diagnosed patients.

Methods

This was a descriptive, cross-sectional, multicentre study. Data were collected from newly diagnosed patients with AF through medical records review and interviews during cardiology, internal medicine, primary care and emergency department consultations in Spain.

Results

A total of 201 physicians participated in the study (64.2% cardiologists, 21.4% internists). 948 patients (58% men; mean age 72.8 years) were included. In 41.8% of patients, AF was classified as paroxysmal at diagnosis, 30.9% as persistent and 27.3% as permanent. The diagnosis was coincidental in 37%. It was considered that a delayed diagnosis occurred in 49.3% of patients. This delay was associated with the presence of permanent or persistent AF, older age or valvular disease. 74.8% of patients had some contact with the healthcare system in the preceding year. The diagnosis could have been established between 1 and 6 months earlier in 50.7% of cases and more than six months earlier in 20.1%. 54.4% of the patients had experienced AF compatible symptomatology previously. Of these, 32.6% had a consultation without a diagnosis.

Conclusions

In a significant proportion of AF cases, there is a diagnostic delay. Many people with compatible symptoms neither seek consultations nor contact the healthcare system facilities. Consequently, the opportunity for early diagnosis is lost.

导言我们分析了新诊断患者心房颤动（房颤）延迟诊断的频率及其相关因素：这是一项描述性、横断面、多中心研究。方法：这是一项描述性横断面多中心研究，通过查阅病历和在西班牙心脏病科、内科、初级保健科和急诊科就诊时进行访谈，收集新确诊房颤患者的数据：共有 201 名医生参与了研究（64.2% 为心脏病专家，21.4% 为内科医生）。共纳入 948 名患者（58% 为男性；平均年龄 72.8 岁）。41.8%的患者在诊断时被归类为阵发性房颤，30.9%的患者被归类为持续性房颤，27.3%的患者被归类为永久性房颤。37%的患者的诊断是巧合。49.3%的患者被认为是诊断延迟。这种延迟与存在永久性或持续性房颤、年龄较大或瓣膜疾病有关。74.8%的患者在前一年与医疗系统有过一些接触。50.7%的病例可在 1-6 个月前确诊，20.1%的病例可在 6 个月前确诊。54.4%的患者之前出现过与房颤相似的症状。结论：结论：很大一部分心房颤动病例存在诊断延误。结论：在很大一部分心房颤动病例中，诊断被延迟了。许多有类似症状的人既不就诊，也不与医疗系统设施联系。因此，丧失了早期诊断的机会。

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引用次数: 0

Results of the implementation of the DP-TRANSFERS project in Catalonia: a translational method to improve diabetes screening and prevention in primary care 在加泰罗尼亚地区实施 DP-TRANSFERS 项目的结果：在初级保健中改进糖尿病筛查和预防的转化方法。

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rceng.2024.08.003

J.J. Cabré , F. Barrio , J. Vizcaíno , A. Martínez , T. Mur , R. Sagarra , S. Dalmau

Introduction

DP-TRANSFERS is a translational lifestyle intervention project, which follows a previous protocol described in the DE-PLAN-CAT study.

Objective

Analyze the feasibility of reproducing the intensive intervention and estimating the effect of translation in real conditions of clinical practice in primary care.

Methodology

Implementation of the face-to-face group intervention adjusted to 2 years. After screening, the intervention consisted of a basic module and a continuity module. Stratifying by clusters (health centers), a representative sample (centers, professionals and participants) was evaluated (FINDRISC > 11 and/or prediabetes) from 2016 to 2020. The effect of the intervention on the incidence of diabetes was analyzed.

Results

The intervention, feasible in 95 of 123 centers, involved 343 of 647 professionals. Of 2381 subjects screened, 1713 participated in the basic module, with 1186 participants completing the first year and 776 completing the second. 121 participants (7.06%) were diagnosed with diabetes: 77 (4.49%) during the first year; 44 (2.57%) during the second.

The bivariate analysis showed that those subjects in whom diabetes affected differed in: previous glycemic status, A1c, HDL-cholesterol, FINDRISC score and adherence to the Mediterranean diet, and in the differences between the beginning and end of the study of: body weight, BMI and abdominal circumference.

Conclusions

The intensive intervention substantially reduced (23.6%) the incidence of diabetes compared to that previously estimated in standardized intervention. The following acted as protective factors: a better glycemic status, lower baseline risk, elevated HDL-cholesterol, or achieving a reduction in weight or abdominal circumference during the study.

项目简介DP-TRANSFERS是一个生活方式干预转化项目，它沿用了DE-PLAN-CAT研究中描述的先前方案：分析在初级保健临床实践的实际条件下复制强化干预的可行性，并估计转化的效果：方法：将面对面小组干预的实施时间调整为 2 年。筛查后，干预包括基本模块和持续模块。按照群组（医疗中心）进行分层，从2016年至2020年对代表性样本（中心、专业人员和参与者）进行评估（FINDRISC>11和/或糖尿病前期）。分析了干预措施对糖尿病发病率的影响：干预措施在 123 个中心中的 95 个可行，647 名专业人员中有 343 人参与。在筛选出的 2381 名受试者中，1713 人参加了基础模块，其中 1186 人完成了第一年的学习，776 人完成了第二年的学习。121名参与者（7.06%）被诊断出患有糖尿病：77人（4.49%）在第一年被诊断出患有糖尿病；44人（2.57%）在第二年被诊断出患有糖尿病。双变量分析显示，受糖尿病影响的受试者在以下方面存在差异：之前的血糖状况、A1c、高密度脂蛋白胆固醇、FINDRISC评分和对地中海饮食的坚持程度，以及研究开始和结束时体重、体重指数和腹围的差异：结论：与之前在标准化干预中估计的糖尿病发病率相比，强化干预大大降低了糖尿病发病率（23.6%）。以下因素起到了保护作用：较好的血糖状况、较低的基线风险、较高的高密度脂蛋白胆固醇，或在研究期间实现了体重或腹围的减少。

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引用次数: 0

Position paper on retinal arterial occlusion. SEMI-SERV 关于视网膜动脉闭塞的立场文件。SEMI-SERV.

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rceng.2024.09.001

R. García-Alonso , L. Arias-Barquet , L. Castilla Guerra , M. Martín Asenjo , A.J. Gómez-Escobar , E. Gutierrez-Sánchez , J. Pagán Escribano , A. Lorenzo Hernández , O. Madridano Cobo , F. Jaén Águila , M.E. Salguero Cámara , N. Muñoz Rivas

The retina is an organ frequently affected by ischemic changes. Retinal arterial occlusion can be considered the equivalent of stroke, in terms of presentation, management and treatment. In addition to a specific ophthalmological treatment systemic management is essential with an appropriate study and control of cardiovascular risk factors considering these patients of a very high cardiovascular risk.

In this consensus document we aim to provide an update on this relatively frequent pathology in our practices, considering the importance of an early and systematic action.

视网膜是经常受到缺血性病变影响的器官。视网膜动脉闭塞症在表现、管理和治疗方面与中风相当。考虑到这些患者具有极高的心血管风险，除了特殊的眼科治疗外，还必须进行系统管理，对心血管风险因素进行适当的研究和控制。在这份共识文件中，我们旨在介绍这种在我们的临床实践中较为常见的病理现象的最新进展，同时考虑到及早采取系统性措施的重要性。

引用次数: 0

Incidence of pregnancy related pulmonary embolism in Spain 2016-2021: an observational population-based retrospective study 2016-2021 年西班牙产前相关肺栓塞发病率：一项基于人口的回顾性观察研究。

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rceng.2024.07.009

J.A. Rueda Camino PhD , A. Azcoaga-Lorenzo PhD , R. Noguero-Meseguer PhD , D. Joya-Seijo , M. Angelina-García , D. Trujillo , C. Miranda , R. Barba-Martín

Objective

This study aimed to estimate the overall and annual age-standardized incidence of pregnancy-related pulmonary embolism (PE) in Spain from 2016 to 2021, explore the distribution of PE events during pregnancy and the postpartum period, identify potential risk factors, and estimate mortality rates during hospital admission.

Methods

In a retrospective, observational, population-based study, data from the Spanish National Hospital Discharge Database were analyzed to identify women with hospital episodes of pregnancy-related-PE. The primary outcome was the overall and annual age-standardized incidence of pregnancy-related-PE, with secondary aims including the distribution of events during pregnancy and postpartum and the calculation of age-standardized mortality rates during admission.

Results

Among 2,178,805 births from 2016 to 2021, 522 women were diagnosed with pregnancy-related PE, yielding an overall age-standardized incidence of 2.83 cases per 10,000 births. A non-significant increasing trend was observed from 2.43 to 4.18 cases per 10,000 births (p = 0.06). Comorbidities were low, with a notable association between PE and SARS-CoV-2 infection during the last two years. The mortality rate among women with pregnancy-related PE was 2.8%, with a higher incidence of PE reported during the postpartum period.

Conclusion

The incidence of pregnancy-related-PE in Spain exhibits a non-significant increasing trend, with a significant risk of mortality. The association with SARS-CoV-2 infection underscores the importance of vigilant monitoring and management of pregnant women, particularly during pandemics. This study contributes specific data on the incidence and characteristics of pregnancy-related-PE in Spain, emphasizing the need to consider PE in the differential diagnosis and management strategies for pregnant and postpartum women.

研究目的本研究旨在估算2016年至2021年西班牙妊娠相关肺栓塞（PE）的总发病率和年度年龄标准化发病率，探讨妊娠期和产后PE事件的分布情况，确定潜在的风险因素，并估算入院期间的死亡率：在一项以人群为基础的回顾性观察研究中，我们分析了西班牙国家医院出院数据库的数据，以确定与妊娠相关的 PE 住院病例。研究的主要结果是妊娠相关脑溢血的总发病率和年度年龄标准化发病率，次要目的包括孕期和产后事件的分布以及入院期间年龄标准化死亡率的计算：在2016-2021年的2 178 805名新生儿中，有522名妇女被确诊为妊娠相关性肺栓塞，总的年龄标准化发病率为每万名新生儿2.83例。从每万名新生儿 2.43 例增至 4.18 例，呈非显著上升趋势（p = 0.06）。合并症较少，但 PE 与最近两年感染 SARS-CoV-2 有明显关联。与妊娠相关的 PE 患者的死亡率为 2.8%，产后 PE 的发病率较高：结论：在西班牙，与妊娠相关的 PE 的发病率呈不明显的上升趋势，且有很大的死亡风险。与 SARS-CoV-2 感染的关联强调了对孕妇进行警惕性监测和管理的重要性，尤其是在流行病期间。这项研究提供了西班牙与妊娠有关的 PE 发病率和特征的具体数据，强调了在对孕妇和产后妇女进行鉴别诊断和管理策略时考虑 PE 的必要性。

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引用次数: 0