Polne razlike u kliničkoj prezentaciji, elektrokardiografskim znacima, laboratorijskim markerima i ishodu kod bolesnika sa akutnom embolijom pluća

  • Slobodan D Obradovic Univerzitet odbrane, Medicinski fakultet VMA
  • Boris Džudović Clinic of Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
  • Siniša Rusović Institute of Radiology, Military Medical Academy, Belgrade, Serbia
  • Vesna Subota Institute of Medical Biochemistry, Military Medical Academy, Belgrade, Serbia
  • Dragana Obradović Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia, ||Clinic of Neurology, Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP150716093O
Ključne reči: pulmonary embolism||, ||pluća, embolija, sex factors||, ||pol, faktor, risk factors||, ||faktori rizika, signs and symptoms||, ||znaci i simptomi, diagnostic techniques and procedures||, ||dijagnostičke tehnike i procedure, electrocardiography||, ||elektrokardiografija, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod/Cilj. Akutna plućna embolija (PE) potencijalno je životnougrožavajuće stanje. Podaci u razlikama među polovima u tom stanju oskudni su. Cilj rada bio je da se identifikuju razlike između polova u pogledu kliničke prezentacije, dijagnostičke specifičnosti i ishoda PE. Metode. Analizirali smo podatke o 144 uzastopna bolesnika sa PE (50% žene) i uporedili muškarce i žene s obzirom na kliničke prezentacije, elektrokardiografske (EKG) znakove, osnovne laboratorijske markere i šestomesečni ishod. Svi bolesnici su imali potvrđen PE na multislajsnoj kompjuterizovanoj tomografiji sa plućnom angiografijom (MSCT-PA), EKG-u i ehokardiografskoj dijagnostici na prijemu. Rezultati. U poređenju sa muškarcima, žene su bile starije i većinom u trećem tercilu životnog doba (66,0% vs 34,0%; p = 0,008). Univarijantna analiza pokazala je da su kod muškaraca na prijemu hemoptizije bile učestalije nego kod žena [OR (95% CI) 3,75 (1,16–12,11)], kao i bol u grudima [OR (95% CI) 3,31 (1,57–7,00)], febrilno stanje [OR (95% CI) 2,41 (1,12–5,22)] i pneumonija [OR (95% CI) 3,40 (1,25–9,22)], a manje verovatna bila je srčana dekompenzacija u ranoj fazi bolesti [OR (95% CI) 0.48 (0.24–0.97)]. Nije bilo značajnih razlika između polova u pojavi tipičnih EKG znakova za PE. Žene su imale viši nivo glikemije na prijemu [7.7 mmol/L (5.5–8.2 mmol/L) vs 6.9 mmol/L (6.3–9.6 mmol/L), p = 0.006] i veći ukupni broj leukocita [10.5 ´ 109/L (8.8–12.7 ´ 109/L) vs 8.7 ´ 109/L (7.0–11.6 ´ 109/L), p = 0.0 07] kao i trend ka višem nivou B-tip natriuretskog peptida u plazmi 127.1 pg/mL (55.0–484.0 pg/mL) vs [90.3 pg/mL (39.2–308.5 pg/ml), p = 0.092]. Krvarenje i smrt, najvažniji šestomesečni ishodi, bili su ravnopravno zastupljeni među polovima. Zaključak. Postoji nekoliko važnih razlika između muškaraca i žena u pogledu kliničke prezentacije i laboratorijskih nalaza karakterističnih za PE, koji mogu uticati na njenu dijagnostiku i lečenje PE.

Biografija autora

Slobodan D Obradovic, Univerzitet odbrane, Medicinski fakultet VMA
Vanredni profesor iz interne medicine, Kardiolog

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Objavljeno
2017/03/10
Broj časopisa
Vol. 73 Br. 9 (2016)
Rubrika
Originalni članak